bluuebunny/crossref_metadata_2025 huggingface dataset:
Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?
Authors: Aojula Nivaran , Khan Shahab , Gittoes Neil , Hassan-Smith Zaki
Published: February 2021

Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and vitamin D; this is known as normocalcaemic PHPT (nPHPT). Studies investigating the clinical presentation of this condition have shown that patients may present with hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis and fragility fractures. The prevalence of such complications in nPHPT is similar to that in classical hypercalcaemic PHPT (hPHPT). Although the National Institute for Health and Care Excellence (NICE) have developed guidelines for the management of PHPT generally, a consensus is yet to be reached on the optimal management of nPHPT specifically. A review of the literature on parathyroidectomy in the treatment of nPHPT revealed that nPHPT patients were more likely to present with multi-glandular disease and significantly less nPHPT patients had an intra-operative PTH fall of >50% compared with those with hPHPT. These findings demonstrate that patients with nPHPT are more likely to receive bilateral neck explorations and require remedial surgery compared with hPHPT patients. Following surgery, improvements in bone mineral density (BMD) and renal stones are generally observed in those with nPHPT. Where surgery is not possible, medical management with alendronate has been shown to be effective in nPHPT patients. Given the higher incidence of multi-gland disease and greater possibility of remedial surgery in nPHPT, careful consideration of risks and benefits should be made on an individualised basis and surgery should be performed by surgeons experienced in four gland exploration.
An incidental latent adult hemophilia case found after a tonsillectomy
Authors: Saikawa Yuichiro , Tsunoda Atsunobu , Sata Naoko , Anzai Takashi
Published: February 2021

Severe bleeding after a tonsillectomy may cause airway obstruction and be life-threatening. We report post-tonsillectomy bleeding in a 32-year-old patient with hemophilia A, who had not been aware of his disease for more than 30 years. He underwent tonsillectomy for recurrent tonsillitis. He denied episodes of bleeding tendency. The preoperative workup was normal, including platelet count, prothrombin time, and activated partial thromboplastin time. The surgery itself was uneventful, but severe bleeding from the inferior pole of the tonsillar bed developed 7 days after surgery. Emergency hemostasis was performed under general anesthesia in the operating room. The patient then remembered several episodes of bleeding tendency. Coagulation tests revealed a mild lack of coagulation factor VIII to 35%, and a diagnosis of hemophilia A was made. Hemophilia might only be found after surgery and can cause life-threatening complications. However, latent hemophilia detected after a tonsillectomy in a 32-year-old adult is very rare. A careful history of bleeding tendency is important to achieve a diagnosis of coagulopathy, perform a safer surgery, and prevent postoperative complications.
Institutional orientation: Definition, measure, and impact on export performance
Authors: Zouari Abir , Chaney Damien
Published: February 2021

Research in international marketing has long shown that foreign firms face disadvantages when operating abroad from a lack of familiarity with the local institutional environment. To cope with this familiarity, some companies have developed a culture in the ability to understand and take into account the institutional dimensions of the destination market. This article thus aims to explore the institutional orientation of firms and tests its impact on export performance. In Study 1, we develop and validate a 12-item measurement scale divided into four dimensions. In Study 2, we investigate the role of institutional orientation in export performance using a sample of 273 French and Tunisian exporting companies. The results show that this relationship is not direct but is mediated by export commitment.
Cannabis and Cigarette Use Before and After Living Kidney Donation
Authors: Bugeja Ann , Shams Ieta , Harris Sophie , Clark Edward G. , Burns Kevin D. , Sood Manish M. , Akbari Ayub
Published: February 2021

Background:

It is unclear whether kidney donation leads to lifestyle changes in terms of cannabis and cigarette use.

Objective:

To describe cigarette and cannabis use before and after kidney donation and to determine their associations with lifestyle and clinical factors.

Design:

Retrospective cohort study.

Setting:

The Living Kidney Donor program in the Champlain Local Health Integration Network at The Ottawa Hospital in Ottawa, Canada.

Patients:

The study included 178 living kidney donors who donated between January 2009 and December 2018.

Measurements:

Donors were screened for cannabis and cigarette use by telephone interview. Their clinical characteristics and changes in kidney function before and after donation were recorded.

Methods:

Cannabis and cigarette use before and after kidney donation were compared using chi-square test. Risk factors associated with their use was examined by univariate and multivariate logistic regression. Wilcoxon rank sum test was used to examine the association of cannabis and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) estimated glomerular filtration rate (eGFR) at donation and at last follow-up. T-test was used to examine the association of cigarette smoking and CKD-EPI eGFR at donation and at last follow-up.

Results:

Among 305 donors, 262 met inclusion criteria and 178 participated (mean of 4.7 ± 2.9 years from kidney donation). Cannabis and cigarette use were reported by 5% (9 of 178) and 13% (23 of 178) at donation. After donation, 8% (14 of 178) and 5% (9 of 178) started cannabis and cigarettes, respectively; 74% (17 of 23) of smokers remained smokers after donation and 88% (53 of 60) who quit smoking before donation did not restart after donation. In multivariate analysis, non-married/common-in-law status was associated with cannabis use (odds ratio, 2.73; 95% confidence interval, 1.05-7.11; P = .04). There was no difference in eGFR pre- or post-donation among cannabis or cigarette users.

Limitations:

The single-center study design limits generalizability. Social desirability bias may have affected survey responses and cigarette smoking was not quantified.

Conclusions:

Cannabis and cigarette use was uncommon in the studied population and was not associated with remaining kidney function. Cannabis use increased post-donation. Most smokers remained smokers after donation and most donors who quit smoking before donation did not restart after donation. This warrants education and support for potential donors who smoke, to quit smoking prior to donation to reduce risks of cardiovascular and end-stage kidney disease.

Trial Registration:

Not applicable as this is not a clinical trial.
Effectiveness of film as a health communication tool to improve perceptions and attitudes in multiple sclerosis
Authors: Chiong-Rivero Horacio , Robers Michael , Martinez Andrea , Manrique Clara P , Diaz Astrid , Polito Kelly , Vajdi Borna , Chan Chan , Burnett Margaret , Delgado Silvia R , Chinea Angel , McCauley Jacob L , Amezcua Lilyana ,   on behalf of the ARHMS investigators
Published: February 2021

Background

Health communication tools like film are capable of reducing health disparities and could be effective in addressing negative illness perceptions of MS in Hispanics/Latinx.

Objective

To test the feasibility of using a culturally appropriate short narrative film to examine illness perceptions overtime and attitudes in Hispanics/Latinx affected with MS.

Methods

Participants were assigned to view a short narrative film (n = 130) or not (n = 106). The Brief Illness Perception Questionnaire (BIPQ) was used to examine illness perceptions at baseline, one and three months. Focus groups were conducted at 6 months. Measures of sociocultural integration were obtained. Individual group BIPQ domains were evaluated over time using paired sample t-test. Multivariate linear regression was used to examine predictors of BIPQ change.

Results

A more positive perception of treatment (p < 0.0001) and understanding (p = 0.0003) were seen at 3 months for those exposed to film. Focus groups were effective in highlighting that the perceived disease prognosis, family support and awareness of MS contributes to attitudes. Exposure to film was found to be the strongest predictor (Beta:6.31, p = 0.01) of BIPQ change at three months.

Conclusion

Our results provide support that a short narrative film of MS in Hispanics/Latinx is a feasible intervention to change perceptions of MS to a more positive view.
A 56-Year-Old Male With Weight Loss, Night Sweats, Dyspnea, and Bladder Cancer
Authors: Sanville Bradley C. , Kuhn Brooks T.
Published: February 2021

A 56-year-old man presented with subacute night sweats, fever, and weight loss with worsening dyspnea. Computed tomography (CT) scan demonstrated miliary pattern of nodules evenly distributed throughout all lung fields. Given the patient’s CT findings and temporal association with Bacille Calmette-Guerin (BCG) immunotherapy for bladder cancer, the patient was diagnosed with disseminated Mycobacterium bovis secondary to BCG bladder instillations.
Bestrophinopathies: perspectives on clinical disease, Bestrophin-1 function and developing therapies
Authors: Singh Grewal Simranjeet , Smith Joseph J. , Carr Amanda-Jayne F.
Published: February 2021

Bestrophinopathies are a group of clinically distinct inherited retinal dystrophies that typically affect the macular region, an area synonymous with central high acuity vision. This spectrum of disorders is caused by mutations in bestrophin1 ( BEST1), a protein thought to act as a Ca2+-activated Cl- channel in the retinal pigment epithelium (RPE) of the eye. Although bestrophinopathies are rare, over 250 individual pathological mutations have been identified in the BEST1 gene, with many reported to have various clinical expressivity and incomplete penetrance. With no current clinical treatments available for patients with bestrophinopathies, understanding the role of BEST1 in cells and the pathological pathways underlying disease has become a priority. Induced pluripotent stem cell (iPSC) technology is helping to uncover disease mechanisms and develop treatments for RPE diseases, like bestrophinopathies. Here, we provide a comprehensive review of the pathophysiology of bestrophinopathies and highlight how patient-derived iPSC-RPE are being used to test new genomic therapies in vitro.
Occurrence of plant secondary metabolite fingerprints in river waters from Eastern Jutland, Denmark
Authors: Nanusha Mulatu Yohannes , Krauss Martin , Sørensen Bettina Gro , Schulze Tobias , Strobel Bjarne W. , Brack Werner
Published: February 2021

Background

A large number of chemicals are constantly introduced to surface water from anthropogenic and natural sources. So far, unlike anthropogenic pollutants, naturally occurring compounds are not included in environmental monitoring programs due to limited knowledge on their occurrence and effects in the environment. Since previous studies suggest that natural compounds might contribute to mixture risks in aquatic ecosystems and for drinking water production, there is a need to increase empirical evidence on the occurrence of these compounds in aquatic systems. To this end, we performed target screening on 160 toxic secondary plant metabolites (PSMs), prioritized in silico for their likelihood of occurrence, persistence, toxicity and mobility in river waters, using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS). The samples were collected during rain events from three Danish rivers from an area covered by grassland, forest and agricultural crops.

Results

In total, 27 targets belonging to different compound classes such as alkaloids, coumarins and flavonoids were detected, among them 12 compounds, which have not been reported in surface waters before. The most prominent compound class was the group of alkaloids with 41% of the detected targets, many of them detected in more than 80% of the samples. Individual compound concentrations were up to several hundred ng/L with the neurotoxic alkaloid coniine from poison hemlock and the flavonoid daidzein reaching maximum concentrations of about 400 and 282 ng/L, respectively. In some samples, especially from Vejle river, the rise in concentration of target compounds were associated with increase in the rain intensity and elevated water table in the river.

Conclusions

The measured natural toxin concentrations are well within the range of those of synthetic environmental contaminants and need to be considered for the assessment of potential risks on aquatic organisms and drinking water production.
Multi-dimensional data integration algorithm based on random walk with restart
Authors: Wen Yuqi , Song Xinyu , Yan Bowei , Yang Xiaoxi , Wu Lianlian , Leng Dongjin , He Song , Bo Xiaochen
Published: February 2021

Background

The accumulation of various multi-omics data and computational approaches for data integration can accelerate the development of precision medicine. However, the algorithm development for multi-omics data integration remains a pressing challenge.

Results

Here, we propose a multi-omics data integration algorithm based on random walk with restart (RWR) on multiplex network. We call the resulting methodology Random Walk with Restart for multi-dimensional data Fusion (RWRF). RWRF uses similarity network of samples as the basis for integration. It constructs the similarity network for each data type and then connects corresponding samples of multiple similarity networks to create a multiplex sample network. By applying RWR on the multiplex network, RWRF uses stationary probability distribution to fuse similarity networks. We applied RWRF to The Cancer Genome Atlas (TCGA) data to identify subtypes in different cancer data sets. Three types of data (mRNA expression, DNA methylation, and microRNA expression data) are integrated and network clustering is conducted. Experiment results show that RWRF performs better than single data type analysis and previous integrative methods.

Conclusions

RWRF provides powerful support to users to decipher the cancer molecular subtypes, thus may benefit precision treatment of specific patients in clinical practice.
Transcriptome dynamics in early in vivo developing and in vitro produced porcine embryos
Authors: van der Weijden Vera A. , Schmidhauser Meret , Kurome Mayuko , Knubben Johannes , Flöter Veronika L. , Wolf Eckhard , Ulbrich Susanne E.
Published: February 2021

Background

The transcriptional changes around the time of embryonic genome activation in pre-implantation embryos indicate that this process is highly dynamic. In vitro produced porcine blastocysts are known to be less competent than in vivo developed blastocysts. To understand the conditions that compromise developmental competence of in vitro embryos, it is crucial to evaluate the transcriptional profile of porcine embryos during pre-implantation stages. In this study, we investigated the transcriptome dynamics in in vivo developed and in vitro produced 4-cell embryos, morulae and hatched blastocysts.

Results

In vivo developed and in vitro produced embryos displayed largely similar transcriptome profiles during development. Enriched canonical pathways from the 4-cell to the morula transition that were shared between in vivo developed and in vitro produced embryos included oxidative phosphorylation and EIF2 signaling. The shared canonical pathways from the morula to the hatched blastocyst transition were 14–3-3-mediated signaling, xenobiotic metabolism general signaling pathway, and NRF2-mediated oxidative stress response. The in vivo developed and in vitro produced hatched blastocysts further were compared to identify molecular signaling pathways indicative of lower developmental competence of in vitro produced hatched blastocysts. A higher metabolic rate and expression of the arginine transporter SLC7A1 were found in in vitro produced hatched blastocysts.

Conclusions

Our findings suggest that embryos with compromised developmental potential are arrested at an early stage of development, while embryos developing to the hatched blastocyst stage display largely similar transcriptome profiles, irrespective of the embryo source. The hatched blastocysts derived from the in vitro fertilization-pipeline showed an enrichment in molecular signaling pathways associated with lower developmental competence, compared to the in vivo developed embryos.
Mapping QTLs for 1000-grain weight and genes controlling hull type using SNP marker in Tartary buckwheat (Fagopyrum tataricum)
Authors: Shi Tao-Xiong , Li Rui-Yuan , Zheng Ran , Chen Qing-Fu , Li Hong-You , Huang Juan , Zhu Li-Wei , Liang Cheng-Gang
Published: February 2021

Background

Tartary buckwheat (Fagopyrum tataricum), an important pseudocereal crop, has high economic value due to its nutritional and medicinal properties. However, dehulling of Tartary buckwheat is difficult owing to its thick and tough hull, which has greatly limited the development of the Tartary buckwheat processing industry. The construction of high-resolution genetic maps serves as a basis for identifying quantitative trait loci (QTLs) and qualitative trait genes for agronomic traits. In this study, a recombinant inbred lines (XJ-RILs) population derived from a cross between the easily dehulled Rice-Tartary type and Tartary buckwheat type was genotyped using restriction site-associated DNA (RAD) sequencing to construct a high-density SNP genetic map. Furthermore, QTLs for 1000-grain weight (TGW) and genes controlling hull type were mapped in multiple environments.

Results

In total, 4151 bin markers comprising 122,185 SNPs were used to construct the genetic linkage map. The map consisted of 8 linkage groups and covered 1444.15 cM, with an average distance of 0.35 cM between adjacent bin markers. Nine QTLs for TGW were detected and distributed on four loci on chromosome 1 and 4. A major locus detected in all three trials was mapped in 38.2–39.8 cM region on chromosome 1, with an LOD score of 18.1–37.0, and explained for 23.6–47.5% of the phenotypic variation. The genes controlling hull type were mapped to chromosome 1 between marker Block330 and Block331, which was closely followed by the major locus for TGW. The expression levels of the seven candidate genes controlling hull type present in the region between Block330 and Block336 was low during grain development, and no significant difference was observed between the parental lines. Six non-synonymous coding SNPs were found between the two parents in the region.

Conclusions

We constructed a high-density SNP genetic map for the first time in Tartary buckwheat. The mapped major loci controlling TGW and hull type will be valuable for gene cloning and revealing the mechanism underlying grain development and easy dehulling, and marker-assisted selection in Tartary buckwheat.
Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis
Authors: Lee Kil-yong , Lee Jaeim , Park Youn Young , Oh Seong Taek
Published: February 2021

Background

Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, we aimed to evaluate the incidence of right colon cancer or colonic adenomatous polyps, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis.

Methods

Patients with uncomplicated right colon diverticulitis (modified Hinchey stage Ia) diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment were included. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved retrospectively from patients’ medical records.

Results

The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.9% (69/330 cases) and advanced adenoma (> 10 mm in diameter; or exhibiting a > 25% villous component or severe dysplasia), including colon cancer, was observed in 9 patients (2.7%).

Conclusions

In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may be necessary because although the colon cancer detection rate is low, it is possible to detect advanced colon adenoma.
Qualitative analysis of challenges and enablers to providing age friendly hospital care in an Australian health system
Authors: Mudge Alison M. , Young Adrienne , McRae Prue , Graham Frederick , Whiting Elizabeth , Hubbard Ruth E.
Published: February 2021

Background

With ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system.

Methods

In this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines.

Results

Twenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce.

Conclusions

Progress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital.
The lab-confirmed interval of COVID-19 clusters and its application in the strength evaluation of prevention and control measures
Authors: Huang Lihong , Wei Liangmin , Jiang Yue , Lin Lijuan
Published: February 2021

Background

The lab-confirmed interval is the date from lab confirmation in a core case (infector) to lab confirmation in a second case (infectee); however, its distribution and application are seldom reported. This study aimed to investigate the lab-confirmed interval and its application in the preliminary evaluation of the strength of disease prevention and control measures.

Methods

Taking European countries and Chinese provinces outside Hubei as examples, we identified 63 infector-infectee pairs from European countries from Wikipedia, and 103 infector-infectee pairs from official public sources in Chinese provinces outside Hubei. The lab-confirmed intervals were obtained through analysis of the collected data and adopting the bootstrap method.

Results

The mean lab-confirmed interval was 2.6 (95% CI: 2.1–3.1) days for Europe and 2.6 (95% CI: 1.9–3.3) days for China outside Hubei, which were shorter than the reported serial intervals. For index patients aged ≥60 years old, the lab-confirmed interval in Europe was slightly longer (mean: 2.9; 95% CI: 2.0–3.6) and obviously longer in China outside Hubei (mean: 3.8; 95% CI: 1.9–5.5) than that for patients aged < 60 years.

Conclusion

Investigation of the lab-confirmed interval can provide additional information on the characteristics of emergent outbreaks and can be a feasible indication to evaluate the strength of prevention and control measures. When the lab-confirmed interval was shorter than the serial interval, it could objectively reflect improvements in laboratory capacity and the surveillance of close contacts.
Sudden neck swelling with rash as late manifestation of COVID-19: a case report
Authors: Giannitto Caterina , Bonifacio Cristiana , Esposito Susanna , Ammirabile Angela , Mercante Giuseppe , De Virgilio Armando , Spriano Giuseppe , Heffler Enrico , Lofino Ludovica , Politi Letterio Salvatore , Balzarini Luca
Published: February 2021

Background

Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature.

Case presentation

We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient’s husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab.

Conclusion

Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.
Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study
Authors: Mengiste Degu Abate , Dirbsa Abebe Tolera , Ayele Behailu Hawulte , Hailegiyorgis Tewodros Tesfa
Published: February 2021

Background

The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia.

Methods

A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant.

Results

From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53–15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02–12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12–7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16–25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity.

Conclusion

This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.
Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals
Authors: Shin Jung-ho , Mizuno Seiko , Okuno Takuya , Itoshima Hisashi , Sasaki Noriko , Kunisawa Susumu , Kaku Mitsuo , Yoshida Makiko , Gu Yoshiaki , Morii Daiichi , Shibayama Keigo , Ohmagari Norio , Imanaka Yuichi
Published: February 2021

Background

The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include “implementing appropriate infection prevention and control” and “appropriate use of antimicrobials,” which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship.

Methods

We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses.

Results

The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistantStaphylococcus aureusantibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion.

The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses.

Conclusions

Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.
Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study
Authors: Aoun Mabel , Khalil Rabab , Mahfoud Walid , Fatfat Haytham , Bou Khalil Line , Alameddine Rashad , Afiouni Nabil , Ibrahim Issam , Hassan Mohamad , Zarzour Haytham , Jebai Ali , Khalil Nina Mourad , Tawil Luay , Mechref Zeina , El Imad Zuhair , Chamma Fadia , Khalil Ayman , Zeidan Sandy , El Ghoul Balsam , Dahdah Georges , Mouawad Sarah , Azar Hiba , Chahine Kamal Abou , Kallab Siba , Moawad Bashir , Fawaz Ahmad , Homsi Joseph , Tabaja Carmen , Delbani Maya , Kallab Rami , Hoballah Hassan , Haykal Wahib , Fares Najat , Rahal Walid , Mroueh Wael , Youssef Mohammed , Rizkallah Jamale , Sebaaly Ziad , Dfouni Antoine , Ghosn Norma , Nawfal Nagi , Jaoude Walid Abou , Bassil Nadine , Maroun Therese , Bassil Nabil , Beaini Chadia , Haddad Boutros , Moubarak Elie , Rabah Houssam , Attieh Amer , Finianos Serge , Chelala Dania
Published: February 2021

Background

Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients.

Methods

This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality.

Results

A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83).

Conclusions

This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.
Physical activity and sedentary time during pregnancy and associations with maternal and fetal health outcomes: an epidemiological study
Authors: Meander Lina , Lindqvist Maria , Mogren Ingrid , Sandlund Jonas , West Christina E. , Domellöf Magnus
Published: February 2021

Background

Physical activity is generally considered safe for the pregnant woman as well as for her fetus. In Sweden, pregnant women without contraindications are recommended to engage in physical activity for at least 30 min per day most days of the week. Physical activity during pregnancy has been associated with decreased risks of adverse health outcomes for the pregnant woman and her offspring. However, there are at present no recommendations regarding sedentary behavior during pregnancy. The aim was to examine the level of physical activity and sedentary time in a representative sample of the pregnant population in Sweden, and to explore potential effects on gestational age, gestational weight gain, birth weight of the child, mode of delivery, blood loss during delivery/postpartum, self-rated health during pregnancy and risk of pregnancy-induced hypertension and preeclampsia.

Methods

This was an epidemiological study using data from the prospective, population-based NorthPop study in Northern Sweden and information on pregnancy outcomes from the national Swedish Pregnancy Register (SPR). A questionnaire regarding physical activity and sedentary time during pregnancy was answered by 2203 pregnant women. Possible differences between categories were analyzed using one-way Analysis of variance and Pearson’s Chi-square test. Associations between the level of physical activity/sedentary time and outcome variables were analyzed with univariable and multivariable logistic regression and linear regression.

Results

Only 27.3% of the included participants reported that they reached the recommended level of physical activity. A higher level of physical activity was associated with a reduced risk of emergency caesarean section, lower gestational weight gain, more favorable self-rated health during pregnancy, and a decreased risk of exceeding the Institute of Medicine’s recommendations regarding gestational weight gain. Higher sedentary time was associated with a non-favorable self-rated health during pregnancy.

Conclusions

Our study showed that only a minority of pregnant women achieved the recommended level of physical activity, and that higher physical activity and lower sedentary time were associated with improved health outcomes. Encouraging pregnant women to increase their physical activity and decrease their sedentary time, may be important factors to improve maternal and fetal/child health outcomes.
Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
Authors: Kawakami Mandira D. , Sanudo Adriana , Teixeira Mônica L. P. , Andreoni Solange , de Castro Josiane Q. X. , Waldvogel Bernadette , Guinsburg Ruth , de Almeida Maria Fernanda
Published: February 2021

Background

It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths.

Methods

Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors.

Results

Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks.

Conclusions

There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.
The 5-year overall survival of cervical cancer in stage IIIC-r was little different to stage I and II: a retrospective analysis from a single center
Authors: Yang E , Huang Shuying , Ran Xuting , Huang Yue , Li Zhengyu
Published: February 2021

Background

The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging guideline for cervical cancer includes stage IIIC recognized by preoperative radiology (IIIC-r) to state there are lymph nodes metastases (LNM) identified by imaging tools. We aim to explore the reasonability and limitations of stage IIIC-r and try to explore the potential reasons.

Methods

Electronic medical records were used to identify patients with cervical cancer. According to the new staging guidelines, patients were reclassified and assigned into five cohorts: stage I, stage II, stage IIIC-r, LNM confirmed by pathology (IIIC-p) and LNM detected by radiology and confirmed by pathology (IIIC r + p). Five-year overall survivals were estimated for each cohort. The diagnosis accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and diameter of detected lymph nodes were also evaluated.

Results

A total of 619 patients were identified. The mean follow-up months were 65 months (95% CI 64.43–65.77) for all patients. By comparison, the 5-year overall survival rates were not statistically different (p = 0.21) among stage IIIC-r, stage I and stage II. While, the rates were both statistical different (p<0.001) among stage IIIC-p, IIIC r + p and stage I and stage II. The sensitivities of CT and MRI in detecting LNM preoperatively were 51.2 and 48.8%. The mean maximum diameter of pelvic lymph nodes detected by CT cohort was 1.2 cm in IIIC-r cohort, and was 1.3 cm in IIIC r + p cohort. While, the mean maximum diameter of pelvic lymph nodes detected by MRI was 1.2 cm in IIIC-r cohort, and was 1.48 cm in IIIC r + p cohort. When the diagnosis efficacy of the diameter of pelvic lymph nodes in detecting LNM were evaluated, the area under the receiver operating characteristic curve (ROC curve) was 0.58 (p = 0.05).

Conclusions

It seems that the FIGO 2018 staging guideline for cervical cancer is likely to has certain limitations for the classification of those with LNM. CT or MRI, however, has limitations on detecting LNM. It would be better to use more accurate imaging tools to identify LNM in the clinical practices.
Relationship between the higher inflammatory cytokines level in the aqueous humor of Fuchs uveitis syndrome and the presence of cataract
Authors: Wang Hui , Tao Yong
Published: February 2021

Background

This study aims to compare the levels of intraocular cytokines between Fuchs uveitis syndrome (FUS) eyes and the senile cataract eyes. The association between inflammatory cytokine levels and cataract severity in FUS is evaluated to find the possible mechanism of cataract in FUS eyes.

Methods

A retrospective study of 28 eyes with FUS was performed. Auxiliary examinations were performed, including ophthalmic examinations, laser flare-cell photometry, and levels of inflammatory cytokines in the aqueous humor were measured. The control group included 25 eyes with senile cataract. Data on the aqueous humor inflammatory cytokines were compared between the two groups. The association between the aqueous humor cytokine levels and severity of posterior subcapsular cataract was assessed.

Results

There were 28 eyes with FUS in 27 patients. Unilateral involvement was noted in 26 patients (96.30%). Stellate keratic precipitates (KPs) were noted in 16 eyes (57.14%). Heterochromia was observed in 21.43% of affected eyes. Posterior subcapsular cataract (PSC) was observed in 16 of the 28 eyes. Eyes with FUS had significantly higher aqueous humor (AH) cytokine levels (VEGF, bFGF, IL-6, IL-8 and IL-10) compared with the control eyes (P < 0.05). There was a statistically significant positive correlation between the severity of cataract and IL-6 and IL-8 levels in the AH (τ = 0.664 and 0.634, respectively;P = 0.001,P = 0.002, respectively).

Conclusions

Expression of VEGF, bFGF, IL-6, IL-8 and IL-10 in the AH of FUS patients was significantly higher than in senile cataract eyes, and the aqueous humor levels of IL-6 and IL-8 were significantly positively associated with the severity of posterior subcapsular cataract. Our results imply that an inflammation mechanism may be involved in the early development of cataract in FUS.
Factors influencing adolescent girls and young women’s participation in a combination HIV prevention intervention in South Africa
Authors: McClinton Appollis Tracy , Duby Zoe , Jonas Kim , Dietrich Janan , Maruping Kealeboga , Abdullah Fareed , Slingers Nevilene , Mathews Catherine
Published: February 2021

Background

For interventions to reach those they are intended for, an understanding of the factors that influence their participation, as well as the facilitators and barriers of participation are needed. This study explores factors associated with participation in a combination HIV prevention intervention targeting adolescent girls and young women (AGYW) aged 15–24-years-old, as well as the perspectives of AGYW, intervention implementers, and facilitators who participated in this intervention.

Methods

This study used mixed-methods approach with quantitative household survey data from 4399 AGYW aged 15–24-years-old in six of the ten districts in which the intervention was implemented. In addition, qualitative methods included a total of 100 semi-structured in-depth interviews and 21 focus group discussions in five of the ten intervention districts with 185 AGYW who participated in one or more of the key components of the intervention, and 13 intervention implementers and 13 facilitators. Thematic analysis was used to explore the perspectives of participating and implementing the intervention.

Results

Findings reveal that almost half of AGYW (48.4%) living in the districts where the intervention took place, participated in at least one of the components of the intervention. For both 15–19-year-olds and 20–24-year-olds, factors associated with increased participation in the intervention included being HIV negative, in school, never been pregnant, and having had a boyfriend. Experiencing intimate partner violence (IPV) and/or sexual violence in the past 12 months was associated with increased levels of participation in the intervention for 20–24-year-olds only. In our analysis of the qualitative data, facilitators to participation included motivating participants to join the interventions through explaining the benefits of the programme. Barriers included misguided expectations about financial rewards or job opportunities; competing responsibilities, interests or activities; family responsibilities including childcare; inappropriate incentives; inability to disrupt the school curriculum and difficulties with conducting interventions after school hours due to safety concerns; miscommunication about meetings; as well as struggles to reach out-of-school AGYW.

Conclusion

Designers of combination HIV prevention interventions need to address the barriers to participation so that AGYW can attend without risking their safety and compromising their family, childcare and schooling responsibilities. Strategies to create demand need to include clear communication about the nature and potential benefits of such interventions, and the inclusion of valued incentives.