bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of urinary Retinol binding protein (RBP) as a novel biomarker in early detection of kidney affection in patients with psoriatic arthritis
Authors: Ibrahim Dina Ahmed Abdel Moneim , Saleh Hala Abdul Hady , Saber Nayera Zaghloul
Published: October 2021

Background

PsA is a chronic multisystem inflammatory disorder with various systemic diseases. Renal involvement in patients with PsA is sparsely studied and its association is still unclear. This entity is called “Psoriatic Nephropathy”. RBP has been proposed as the most sensitive marker for detection of renal tubule function loss.

Aim

We aim at early detection of renal tubular damage by measuring the level of urinary RBP as a novel biomarker in patients with psoriatic arthritis in relation to activity and severity.

Methods

We conducted a Cross-sectional study of 30 PsA patients from Physical Medicine, Rheumatology and Rehabilitation and Dermatology outpatients’ clinics at Ain Shams University Hospitals. They were subjected to full medical history taking and thorough clinical examination with calculation of DAS 28, PASI and HAQ scores. Full Laboratory evaluation included CBC, ESR, CRP, serum creatinine, BUN, SGOT, SGPT, urine analysis, estimated GFR (eGFR) and urinary RBP were measured for all the participants. The urinary RBP and eGFR were compared with 30 age and sex matched healthy controls.

Results

The urinary RBP mean±SD (ng/ml) was found to be 351.667±119.397 in patients and was statistically significantly higher in them than in controls 93.16±30.836 (t = 11.482, p < 0.001) and it was statistically significantly correlated with disease duration, disease activity according to DAS 28 and the severity of skin affection according to PASI score. While eGFR (ml/min) was found to be 131.729±28.943 in patients and it was statistically significantly lower in them than in controls 146.708±16.607 (t=-2.459, p = 0.017), however there was no statistically significant correlations with either DAS 28 or PASI scores.

Conclusion

Urinary RBP has been described as a novel biomarker in early detection of kidney affection and renal tubular damage in psoriatic arthritis patients.
Anti carbamylated protein antibodies as a diagnostic marker in patients with rheumatoid arthritis and its association with disease activity
Authors: El debsy Magda Medhat Awad , Hakim Mervat Mohammed Abdul , Khaled Henaz Farouk , El Sabour Sabbah Hala Mohamed Abd
Published: October 2021

Background

Despite the diagnostic contribution of anti-citrullinated protein( anti-CCP) antibody and rheumatoid factor (RF), approximately one-third of patients with rheumatoid arthritis (RA) remain seronegative .Anti-carbamylated protein (Anti-Carp) antibodies have been attracting increasing attention as a new diagnostic marker of RA.

Objective

evaluate levels of anti-carp antibodies in RA patients in order to detect its role as a diagnostic marker and its possible association with disease activity and severity.

Methods

This study included thirty adult patients with clinical evidence of rheumatoid arthritis and thirty healthy matched age and sex as controls. All underwent history taking, clinical examination, assessment of disease activity with modified Disease Activity28 (DAS28), Laboratory investigations including Complete blood count (CBC), erythrocytes sedimentation rate (ESR), C-Reactive Protein (CRP), Liver function tests, Kidney function tests, Serum uric acid, RF, anti CCP Ab, anti-Carp Ab and radiographic Assessment with Larsen score.

Results

Plasma levels of anti-Carp Ab were significantly higher in patients than control group (p > 0,001) with sensitivity of 73.33% and specificity of 100%.it showed significant positive correlation with CRP (r = 0.37 )(p < 0.05) as a marker of activity of RA and also there was significant positive correlation with RF and ACPA (r = 0.45)(r = 0.48) (p < 0.05) respectively as a diagnostic marker for RA. Plasma levels of anti-Carp Ab were higher in patients with more joints damage and erosions as assessed by Larsen radiological score as there was a highly significant correlation between Larsen score and serum Anti-Carp(r = 0.61)(p < 0.001)..

Conclusion

serum Anti–Carp antibody level was higher in RA patients which serve as a diagnostic marker for RA, also its significant correlation with CRP and Larsen score may serve as a marker for disease progression and severity.
Awareness about the New Social Health Insurance System, among Physicians in Primary Health Care Centers in Cairo governorate, and Factors Affecting it
Authors: Soliman M , Gaafary M , Nabih D , Rady M
Published: October 2021

Introduction

The Government of Egypt is committed to attain Universal Health Coverage (UHC), and its progress in this vein has been spurred recently through the approval of the Social Health Insurance (SHI) law. Health providers are important stakeholders in the implementation of the SHI system.

Objective

The objective of this study was to estimate the level of awareness of physicians and managers in Primary Health Care Centers (PHCCs) in Cairo governorate about the new system and the factors affecting it.

Method

A cross-sectional study was conducted to estimate the awareness level of 100 physicians and managers from PHCCs in Cairo governorate in 2019. PHCCs subjected to this study were selected randomly from the official list of the PHCCs in Cairo governorate from the MOH, and the required sample of physicians was randomly selected inside each center. A semi-structured Arabic interview questionnaire was used, with a reliability coefficient of 0.70.

Results

The study revealed that the respondents’ awareness level of the new SHI System was mostly average (78% between Q1-Q3 of the total awareness score). Only 54% of the participants considered themselves aware of the new SHI system. 82% of the respondents expressed their desire to get more information about the new SHI system. The majority of participants (88%) reported that they did not attend any induction or training courses regarding the SHI system. Only 4% of the respondents stated that they are fully and clearly aware of their role in the new SHI system. Managers and older participants showed significantly higher means of awareness than the competitors groups.

Conclusion

The study concluded that the level of awareness about the SHI among the studied sample of the PHCCs physicians at Cairo governorate was averaged. Recommendation: Efforts should be enhanced for reaching out to the physicians in PHCCs, including those working in governorates where implementation of SHI system hasn’t commenced yet, especially to emphasize their understanding of the objectives and elements of the new system.
Effect of Weight Loss Program on Anthropometric and Laboratory Measurements among Adult Obese Females: An Intervention Study
Authors: Ahmed Ola S , Sos Dalia G , Boulos Dina N. K , El-Damaty Samia I , Samy Maysa A
Published: October 2021

Background

Obesity is a complex disease involving an excessive amount of body fat. It is a medical problem that increases the risk of heart disease, diabetes, high blood pressure and certain cancers. New evidence supports the view that there is a relationship between consuming energy restricted diet during weight loss program on anthropometric measurements, example; weight, waist circumference, hip circumference and fat percentage. Objectives: to study the effect of weight loss program on anthropometric and laboratory measurements of adult obese females. Method: an intervention study was carried out in the obesity management clinics of National Nutritional institute.

Results

our findings demonstrate that energy restriction regimen results in modest effect on anthropometric and laboratory measurements which is statistically highly significant. Conclusion and Recommendation: Prevention of obesity should be a high priority in public health, with particular emphasis on encouraging healthy lifestyles in all age groups, starting from early childhood.
Causes and Associated factors of Operation Cancellation at Cardiothoracic Ain-Shams University Hospital
Authors: El Bokl Shaymaa M , Aboul-Fotouh Aisha M , Habil Ehab S , Saleh Ahmed A , Hassan Azza M
Published: October 2021

Background

Cancellation of elective operations is a sensitive indicator of operating room management. It results in loss of time, resources and affects quality of care. Operating room cancellation of elective operations is defined as cases that appeared in the definitive operative room list that ultimately were not performed on that day.

Objectives

To measure cancellation rate at Cardiothoracic Ain-Shams University hospital, Egypt and to identify causes and factors associated to cancellations.

Methods

Cross-sectional study that included 254 operations in all operating rooms of Cardiothoracic Ain Shams university hospital which provides specialized tertiary level of care.

Results

The overall cancellation rate is 21.7%, The most frequent cause of cancellation is standby operations accounting for 29.4%. Pareto chart shows that vital few causes are “patient prepared as stand by”, “previous long operation”, “change in Patient’s clinical status”, “equipment failure” and “ICU bed unavailable”. These causes are responsible for 80% of cancellations.

Conclusion and Recommendation

The avoidable causes of the problem should be addressed. Policy changes are recommended as well as continuous documentation and analysis of cancellation and its causes. Periodic awareness lectures for health care providers are suggested.
Telegeriatrics during the COVID-19 pandemic
Authors: Wahba Hoda , Emara Tamer , Elbokl Ahmed
Published: October 2021

Background

Ain Shams University Virtual Hospital (AVH) has been offering telemedicine services since 2016. During the COVID-19 pandemic it has become essential to offer healthcare services in a safe way. Telemedicine was the perfect choice worldwide to compensate for the deficiency of physical healthcare services. Limitations especially in the elderly population questioned the feasibility of the telegeriatrics model.

Aim

To study the feasibility and acceptability of the AVH telemedicine model in geriatric patients.

Methodology

A cross-sectional study performed from April to October 2020 recruiting patients above 60 years receiving telemedicine services as part of the telemedicine program delivered via AVH. Data was collected via Google forms that were sent to the patients and physicians via Whats app.

Results

1471 patients were triaged via the Whats app managed by geriatric consultants and 64 received video consultations. 849 patients responded to the surveys from all age groups of which 21.8% were above 60 years. From the responders 19.7% consulted geriatric medicine while the 2.1% consulted other specialties. Most satisfaction domains were 85% and above positive responses with an insignificant difference between age groups. 90% of physicians felt confident in their medical management using telemedicine. Conclusion: telegeriatrics is feasible as it is well accepted, easily used and preferred over clinic visits during the COVID-19 pandemic and after, by patients. Physicians are confident in their management using it.
The effects of feeding benzoic acid and/or live active yeast (Saccharomyces cerevisiae) on beef cattle performance, feeding behavior, and carcass characteristics
Authors: Williams Melissa S , Mandell Ira Brent , Bohrer Benjamin M , Wood Katharine M
Published: October 2021

Fifty-nine Angus-cross finishing steers were used to evaluate benzoic acid, active dry yeast (Saccharomyces cerevisiae), or a combination of benzoic acid and active dry yeast when supplemented in a high-grain finishing diet on live animal performance, feeding behavior, and carcass characteristics. Steers were fed a high-grain diet for the final 106 d of finishing. Treatments were as follows: no additional supplementation (CON), 0.5% benzoic acid (ACD), 3 g per head per day active dry S. cerevisiae (YST), or both 0.5% benzoic acid and 3 g/head per day S. cerevisiae (AY). Steers were weighed every 14 d, and ultrasound was performed for rib and rump fat thickness at the beginning (day 1), middle (day 57), and end (day 99) of the experiment. Insert feeding stations were used to collect individual feeding behavior data and DMI daily throughout. Blood samples were collected on days 21 and 22 and days 99–101 to assess plane of nutrition and metabolism. Ruminal fluid samples were collected by oral gavage 4 wk prior to slaughter. Carcass characteristics were examined at a federally inspected slaughter facility. Data were analyzed using PROC GLIMMIX of SAS with initial body weight (BW) as a covariate. Benzoic acid supplementation increased (P = 0.002) overall dry matter intake (DMI) compared to YST and CON steers, which may be due to a faster eating rate (P ≤ 0.008). Animal performance parameters (BW, average daily gain, feed conversion, and ultrasound fat depth) were not different (P ≥ 0.11) among treatment groups. Aspartate aminotransferase concentration was greatest (P ≤ 0.01) for YST steers, which may have been reflected in numerically greater liver abscesses. Carcass traits did not differ (P ≥ 0.33) among treatment groups. Ruminal pH was greater (P = 0.006) for ACD steers than AY steers (pH of 6.16 vs. 5.66, respectively), which indicated that there may be an interactive effect between benzoic acid and active dry yeast. To summarize, steers fed a high-grain finishing diet supplemented with benzoic acid, active dry yeast, or both benzoic acid and active dry yeast had similar growth performance and carcass characteristics compared to those without supplementation. However, the addition of benzoic acid alone increased DMI, variation in DMI, eating rate, and ruminal pH. Future studies are warranted to further investigate the impacts of benzoic acid on the ruminal environment of feedlot cattle.
Temporal and spatial trends in human visceral leishmaniasis in an endemic area in Northeast Brazil and their association with social vulnerability
Authors: Andrade Acácio W F , Souza Carlos D F , Carmo Rodrigo F
Published: October 2021

Background

Visceral leishmaniasis is a neglected tropical disease of great importance to public health due to its wide distribution and close relationship with social and economic conditions. This study aimed to analyse the spatiotemporal dynamics of human visceral leishmaniasis (HVL) in an endemic state in the Northeast Region of Brazil and its spatial correlation with the Social Vulnerability Index (SVI) and the Municipal Human Development Index (MHDI).

Methods

The study included all confirmed cases of HVL in Bahia from 2010 to 2017. A joinpoint regression model was used for trend analysis. Incidence rates were smoothed by a local empirical Bayesian model. Global and local Moran indices and space–time scan statistics were used for identification of spatial clusters. Bivariate and multivariate analyses were carried out to investigate the relationship between HVL incidence and the SVI and MHDI.

Results

Cases of HVL demonstrated stationary behaviour during the period analysed. A significant association was observed between the HVL incidence rate and social vulnerability, with high-risk clusters concentrated in the central region of the state.

Conclusions

HVL has a strong correlation with social vulnerability in the state of Bahia. This study may provide assistance in planning actions and organizing health services to combat HVL.
Phylogenetic Diversity and Phenotypic Characterization of Phlyctema vagabunda (syn. Neofabraea alba) and Neofabraea kienholzii Causing Postharvest Bull’s Eye Rot of Apple in Northern Italy
Authors: Amaral Carneiro Greice , Walcher Magdalena , Storti Alberto , Baric Sanja
Published: October 2021

Bull’s eye rot, caused by Phlyctema vagabunda and Neofabraea species, is one of the most important postharvest diseases of apple. South Tyrol (northern Italy) is the largest continuous apple-producing area in Europe, with approximately 1 million tons being produced yearly and conserved in technologically advanced storage facilities for several months. Still, studies on the pathogen species causing postharvest bull’s eye rot of apple, as well as their diversity and biology, are lacking for this region. Therefore, the main purpose of the present work was to identify and characterize fungal isolates obtained from decayed apple fruit with symptoms of bull’s eye rot that were collected in 2018 and 2019 in different packinghouses in South Tyrol. Among more than 1,000 fungal isolates that were obtained, 419 could be assigned to the genera Phlyctema and/or Neofabraea based on rot symptoms on apple fruit and colony morphology on potato dextrose agar. A smaller subset of 101 representative isolates was further analyzed by DNA sequencing of the internal transcribed spacer region. Furthermore, partial segments of the β-tubulin gene, the translation elongation factor 1α gene, and the 16S mitochondrial ribosomal RNA gene were studied. The phylogenetic analyses, including sequences of reference species, showed that P. vagabunda is the dominant species associated with bull’s eye rot of apple in the study area, whereas Neofabraea kienholzii was found only on a small number of apple fruit samples. The combination of multilocus sequence data revealed 11 unique genotypes that belonged to P. vagabunda and four to N. kienholzii. To the best of our knowledge, this study is the first to report N. kienholzii as a postharvest pathogen of apple in Italy. Finally, a pathogenicity test demonstrated different degrees of virulence among selected isolates of P. vagabunda and N. kienholzii on the cultivar Golden Delicious. The present study emphasizes the importance of accurate species identification, because different species may vary in their biological and pathogenic characteristics, and consequently require distinct disease management strategies, both in the field and during the postharvest stages.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Rapid Detection of Peach Shoot Blight Caused by Phomopsis amygdali Utilizing a New Target Gene Identified from Genome Sequences Within Loop-Mediated Isothermal Amplification
Authors: Yang Lina , Zhang Liang , Cao Jun , Wang Lingyun , Shi Hengsong , Zhu Feng , Ji Zhaolin
Published: October 2021

Peach shoot blight (PSB), caused by Phomopsis amygdali, is a serious threat to the healthy development of the peach industry and leads to 30 to 50% damage to peach production in southern China. In this study, loop-mediated isothermal amplification (LAMP) technology was used to detect the P. amygdali target of a gene of GME6801 that was unique in the whole genome of the pathogen compared with that of Diaporthe (Phomopsis) longicolla TWH P74, Fusarium graminearum PH-1, Colletotrichum gloeosporioides SMCG1 and Magnaporthe oryzae 70-15. Blast comparison of this gene sequence in NCBI database showed that no homologous sequences were found. Therefore, the gene sequence of GME6801 was used to design two pairs of LAMP primers and one pair of PCR primers. The results showed that both primer sets were specific to the 15 strains of P. amygdali, and the other 15 fungal strains presented negative reactions, similar to the control. In addition, 50 pg of genomic DNA of P. amygdali in a 25-μl reaction system could be detected by LAMP assay, which was 100 times more sensitive than PCR. Furthermore, the GME6801 LAMP assay was used to detect artificially inoculated twigs of the pathogen, disease twigs within significantly symptomatic PSB in the fields, and healthy twigs in the same orchard, with detection rates of 100, 75, and 20.8%, respectively. However, detection rates of conventional PCR were separately 100, 62.5, and 16.7%. The results indicated that GME6801-based LAMP could be used for P. amygdali detection as its specificity, sensitivity, and simplicity. This study provides a rapid experimental basis for the identification and prediction of P. amygdali that causes PSB and is beneficial for precise prevention and control of the disease.
COVID-19 and X-linked agammaglobulinemia (XLA) – insights from a monogenic antibody deficiency
Authors: Ponsford Mark J. , Shillitoe Benjamin M.J. , Humphreys Ian R. , Gennery Andrew R. , Jolles Stephen
Published: October 2021

Purpose of review

The clinical outcomes from COVID-19 in monogenic causes of predominant antibody deficiency have pivotal implications for our understanding of the antiviral contribution of humoral immunity. This review summarizes the lessons learned from COVID-19 infection in X-linked agammaglobulinemia (XLA) due to genetic defects in Bruton's tyrosine kinase (BTK).

Recent findings

Key molecular pathways underlying the development of severe COVID-19 are emerging, highlighting the possible contribution of BTK to hyperinflammation. SARS-CoV-2 specific T-cell responses and complement activation appear insufficient to achieve viral clearance in some B-cell deficient individuals. Whilst appearing efficacious in this group, use of convalescent plasma has been recently associated with the evolution of viral escape variants. Early data suggests individuals with XLA can mount a viral-specific T-cell vaccine response, however, the clinical significance of this is still emerging.

In contrast to reports made early in the pandemic, we show XLA patients remain susceptible to severe disease. Persistent infection was common and is likely to carry a significant symptom burden and risk of novel variant evolution. COVID-19 infection in this vulnerable, antibody deficient group due to genetic, therapeutic or disease causes may require prompt and specific intervention for both patient and societal benefit.
Surgeons Consider Initial Nonoperative Treatment With Potential for Future Conversion to Reverse Arthroplasty a Reasonable Option for Older, Relatively Infirm, and Less-Active Patients
Authors: Shu Ryan , Crijns Tom , Ring David , Fatehi Amirreza ,   on behalf of the Science of Variation Group
Published: October 2021

Objectives:

Two recent developments favor initial nonoperative treatment of proximal humerus fractures among the older, relatively infirm, less-active patients that represent most patients with such fractures: (1) evidence of minimal benefit of open reduction, internal fixation over nonoperative treatment, and (2) evidence of the effectiveness of the reverse total shoulder arthroplasty. As one step in determining the feasibility of a strategy of initial nonoperative treatment of proximal humerus fracture among older, relatively infirm, less-active people, we performed a survey-based experiment to measure factors associated with surgeon recommendation for initial nonoperative treatment.

Methods:

Members of the Science of Variation Group viewed 8 hypothetical patients with radiographs of complex proximal humeral fractures and 7 randomized patient variables. For each scenario, surgeons were asked whether they would recommend (1) initial nonoperative treatment with bailout reverse arthroplasty or (2) immediate reverse arthroplasty.

Results:

The mean percentage of recommendations for initial nonoperative treatment was 63%, with wide variation by surgeon (range 0%–100%). In multilevel mixed-effects logistic regression, recommendation for initial nonoperative treatment was associated with specific radiographs, older age, having a comorbidity, being homebound, surgical subspecialists, and more than 20 years in practice.

Conclusions:

These findings suggest that surgeons may consider initial nonoperative treatment with potential for future conversion to reverse arthroplasty an acceptable treatment option, particularly for older, less-active, more infirm individuals, and relatively less displaced fractures with little comminution.
In vivo 3-Dimensional Kinematics Study of the Healthy Cervical Spine Based on CBCT Combined with 3D-3D Registration Technology
Authors: Tang Benyu , Yao Haoqun , Wang Shaobai , Zhong Yanlong , Cao Kai , Wan Zongmiao
Published: October 2021

Study Design.

A cervical biomechanical study.

Objective.

We sought to demonstrate the three-dimensional (3D) intervertebral motion characteristics of the cervical spine in healthy volunteers using cone beam computed tomography (CBCT) combined with 3D-3D registration technology.

Summary of Background Data.

No previous studies have used CBCT combined with 3D-3D registration technology to successfully documented in vivo 3D intervertebral six-degrees-of-freedom (6-DOF) motions of the cervical spine.

Methods.

Twenty healthy subjects underwent cervical (C1–C7) CBCT scans in seven functional positions. Segmented 3D vertebral body models were established according to the cervical CBCT images. A 3D-to-3D registration was then performed for each vertebral body in the different positions to calculate the 3D segmental motion characteristics in vivo.

Results.

During flexion–extension, the range-of-motion (ROM) of C1–C2 and C4–C5 was significantly greater than the other segments. The average coupled axial rotation and lateral bending of each segment were between 0.6° and 3.2°. The average coupling translations in all directions were between 0.2 and 2.1 mm. During axial rotation, the ROM of C1–C2 was 65.8 ± 5.9°, which accounted for approximately 70% of all axial rotation. The motion and displacement of C1–C2 coupled lateral bending were 11.4 ± 5.2° and 8.3 ± 1.9 mm, respectively. During lateral bending, the ROM of C3–C4 was significantly greater than C1–C2, C5–C6, and C6–C7. The coupled axial rotation of C1–C2 was 34.4 ± 8.1°, and the coupled lateral translation was 3.8 ± 0.5 mm. The coupled superoinferior and anteroposterior translation of each cervical segment were between 0.1 and 0.6 mm.

Conclusion.

CBCT combined with 3D-3D registration was used to accurately measure and record the ROMs of lateral bending, axial rotation, and flexion–extension in cervical vertebrae under physiological-load conditions. Our findings may contribute to the diagnosis of cervical spinal disease, the development of new surgical techniques, and the restoration of normal, cervical segmental movement.

Level of Evidence: 3
Scheuermann Kyphosis Patients Have a Similar Revision and Infection Rate to Adolescent Idiopathic Scoliosis Patients
Authors: Sarwahi Vishal , Hasan Sayyida , Koutsogiannis Petros , Dzaugis Peter , Vora Rushabh , Molloy Sean , Benton Adam , Yu Haiming , Khoyratty Sara , Lo Yungtai , Amaral Terry , Lui Darren
Published: October 2021

Study Design.

Multicenter retrospective review.

Objective.

This study aims to address major postoperative complications associated with Scheuermann kyphosis (SK) when compared with adolescent idiopathic scoliosis (AIS) in a large population matched by demographic characteristics, levels fused and operative technique.

Summary of Background Data.

Prior studies have found that SK patients are 3.86 times more likely to experience major postoperative complications than in AIS. Historically, however, these studies have often had populations that were significantly different between the two groups in terms of disease severity, demographics, and small sample sizes.

Methods.

AIS patients were compared to SK patients between 2006 and 2018 contemporaneously. All surgeries were conducted by six surgeons among two institutions. Complications and revisions were calculated. A sub-analysis comparing SK and AIS patients by age, sex, and levels-fused in one-to-one matched pairs was performed as well as a sub-analysis matched by levels fused only in one-to-one matched pairs.

Results.

One thousand three hundred twenty two patients were reviewed (1222 AIS; 100 SK). There were 52 (4.3%) complications in the AIS group compared with 20 (20%) complications in the SK group (P < 0.001), with infections and revisions consisting of the majority of complication rates in both cohorts.

When matched by age, sex, and levels fused, there were eight complications in the AIS group and 11 in the SK group (P = 0.63), with infection and revision rates being similar, (P = 0.29) and (P = 0.26) respectively.

When matched by levels fused only, EBL, operative time and complication rates remained similar (P > 0.05).

Conclusion.

Contrary to previously published literature, our analyses indicate that in a matched population, postoperative complication rates (i.e., infection and revision rates) are not significantly different between SK and AIS patients.

Level of Evidence: 4
The Return on Investment of a Province-Wide Quality Improvement Initiative for Reducing In-Hospital Sepsis Rates and Mortality in British Columbia, Canada
Authors: Khowaja Asif Raza , Willms Alexander J. , Krause Christina , Carriere Sarah , Ridout Ben , Kennedy Colleen , Young Eric , Mitton Craig , Kissoon Niranjan , Sweet David D.
Published: October 2021

OBJECTIVES:

Sepsis is a life-threatening medical emergency. There is a paucity of information on whether quality improvement approaches reduce the in-hospital sepsis caseload or save lives and decrease the healthcare system and society’s cost at the provincial/national levels. This study aimed to assess the outcomes and economic impact of a province-wide quality improvement initiative in Canada.

DESIGN:

Retrospective population-based study with interrupted time series and return on investment analyses.

SETTING:

The sepsis cases and deaths averted over time for British Columbia were calculated and compared with the rest of Canada (excluding Quebec and three territories).

PATIENTS:

Aggregate data were obtained from the Canadian Institute for Health Information on risk-adjusted in-hospital sepsis rates and sepsis mortality in acute care sites across Canada.

INTERVENTIONS:

In 2012, the British Columbia Sepsis Network was formed to reduce sepsis occurrence and mortality through education, knowledge translation, and quality improvement.

MEASUREMENTS AND MAIN RESULTS:

A return on investment analysis compared the financial investment for the British Columbia Sepsis Network with the savings from averted sepsis occurrence and mortality. An estimated 981 sepsis cases and 172 deaths were averted in the post-British Columbia Sepsis Network period (2014–2018). The total cost, including the development and implementation of British Columbia Sepsis Network, was $449,962. Net savings due to cases averted after program costs were considered were $50.6 million in 2018. This translates into a return of $112.5 for every dollar invested.

CONCLUSIONS:

British Columbia Sepsis Network appears to have averted a greater number of sepsis cases and deaths in British Columbia than the national average and yielded a positive return on investment. Our findings strengthen the policy argument for targeted quality improvement initiatives for sepsis care and provide a model of care for other provinces in Canada and elsewhere globally.
Examining Associations Between Food Insecurity, Inhibitory Control, and Body Mass Index in Preschoolers
Authors: Ireland Mariah , Bryant Lindsey M. , Finders Jennifer K. , Duncan Robert J. , Purpura David J. , Schmitt Sara A.
Published: October 2021

Objective:

This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood.

Method:

The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity.

Results:

A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control.

Conclusion:

This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.
A Retrospective Look at Patient, Procedural, and Follow-up Characteristics Associated With WATCHMAN Implantation
Authors: Fowler Susan B. , Sendin Mary Janette
Published: October 2021

Background

Persons with atrial fibrillation (AF) are at risk for stroke. Atrial fibrillation–related strokes most often result for emboli arising from the left atrial appendage (LAA). Stroke prevention includes the use of anticoagulants and/or antiplatelets. These medications can result in bleeding complications. An alternative to anticoagulants is the WATCHMAN device, which is delivered in the left atria resulting in closure of LAA.

Objective

The aim of this study was to describe patient, procedural, and follow-up characteristics in patients who have undergone WATCHMAN implantation.

Methods

This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database.

Results

During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiogram at 45 days indicated that the LAA seal showed no leak or flow around the device or a leak less than 5 mm. At 1 year, 95% (n = 36) of patients were only taking a single antiplatelet drug with aspirin. Eight patients were on a single antiplatelet medication at the time of follow-up 2 years after the procedure.

Discussion

A skilled team including a designated AF clinical nurse specialist contributed to program success measured by efficient placement of the WATCHMAN device and discontinuation of anticoagulation.
American Proctology Before 1899, Part 2: The Rise of the Rectal Specialists
Authors: Janssen Diederik F.
Published: October 2021

Joseph M. Mathews’ study at St. Mark’s Hospital (London) in the 1877 to 1878 winter was followed shortly by a landmark move toward specialization in the United States: Mathews’ heading of a Special Commission on Rectal Diseases appointed at the 23rd Annual Session of the Kentucky State Medical Society, held April 2 to 4, 1878. Various “rectal specialists,” under various makeshift titles, were lecturing and publishing by the mid-1890s. The world’s first proctologic journal, published between 1894 and 1898, was Mathews’ Medical Quarterly, from its inception interpellating a community of colleagues.
Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients
Authors: Cher Wen Qi , Lee Vanessa , Wang Rachel , Cheah Sue-Mei , Lee York Tien , Saffari Seyed Ehsan , Tan Chin-Bee , Chong Chia-Yin , Lam Joyce C. M. , Loh Amos H. P.
Published: October 2021

Background:

The relationship of early catheter-related bloodstream infections (CRBSIs) with perioperative neutropenia and antibiotic prophylaxis is not well established. We sought to evaluate perioperative factors associated with early CRBSIs in newly diagnosed pediatric cancer patients, particularly hematologic indices and antibiotic use.

Methods:

We retrospectively reviewed national registry records of newly diagnosed pediatric cancer patients with port-a-caths inserted using standardized perioperative protocols where only antibiotic use was not regulated. Thirty-day postoperative CRBSI incidence was correlated with preoperative factors using logistic regression and with postoperative blood counts using linear trend analysis.

Results:

Among 243 patients, 17 CRBSIs (7.0%) occurred at median 14 (range, 8–28) postoperative days. Early CRBSIs were significantly associated with cancer type [acute myeloid leukemia and other leukemias (AML/OLs) vs. solid tumors and lymphomas (STLs): odds ratio (OR), 5.09; P = 0.0036; acute lymphoblastic leukemia vs. STL: OR 0.83; P = 0.0446] but not preoperative antibiotics, absolute neutrophil counts and white blood cell counts. Thirty-day postoperative absolute neutrophil counts and white blood cell trends differed significantly between patients with acute lymphoblastic leukemia and STLs (OR 0.83, P < 0.05) and between AML/OLs and STLs (OR 5.09, P < 0.005), with AML/OL patients having the most protracted neutropenia during this period.

Conclusions:

Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates. Instead, AML/OL patients, particularly those with prolonged neutropenia during the first 30 postoperative days, were at increased risk. Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropenia as a major contributing factor for early CRBSI.
Opioid Prescribing Patterns Among Orthopedic Hand Surgeons After Implementation of a Divisional Protocol
Authors: Pflug Emily M. , Huang Shengnan , Haquebord Jacques H. , Hutzler Lorraine , Paksima Nader
Published: October 2021

Introduction:

Overprescribing contributes to the misuse and overuse of narcotics. We hypothesized that implementation of postoperative prescribing guidelines would consistently reduce the amount of opioids prescribed after ambulatory hand surgery.

Methods:

A divisional protocol was instituted in November 2018. A retrospective cohort study was designed to examine the policy's effects on postoperative prescribing. Postoperative opioid prescriptions for patients undergoing ambulatory hand surgery were evaluated 1 year before and 1 year after policy initiation. All prescriptions were converted into the total oral morphine equivalent (OME) prescribed.

Results:

A total of 1,672 surgeries were included. Six hundred sixty-one cases were in preimplementation group, and 1,011 cases were in the postimplementation group. The median of total OME decreased significantly after distribution of prescribing guidelines from 75 in the preimplementation group to 45 in the postimplementation group (p < .001) with significant reductions seen for carpal tunnel release (p < .001), trigger finger release (p < .001), distal radius open reduction internal fixation (p < .001), and finger closed reduction and pinning (p < .001). When categorized by procedure type, the median of total OME decreased from 75 to 30 for soft tissue procedures (p < .001) and from 120 to 100 for bony procedures (p < .001).

Conclusion:

Divisional prescribing guidelines lead to consistent short-term to mid-term reductions in the amount of opioid medication prescribed postoperatively.
Exploring the Relationship Between Objective Pupillometry Metrics and Midline Shift
Authors: Giamarino Kathryn , Blessing Robert , Boelter Christopher , Thompson Julie A. , Reynolds Staci S.
Published: October 2021

BACKGROUND: Pupillary examinations provide early subtle signs of worsening intracranial pathology. Objective pupillomtery assessment, although not yet the standard of care, is considered best practice. However, inconsistent findings from objective pupillometry studies have caused a lack of consensus among clinicians; as such, no clinical guidelines are available to guide clinical use of objective pupillometer devices. To add to the body of evidence, the purpose of this project was to explore the relationship between objective pupillometry metrics and midline shift (MLS). METHODS: A retrospective chart review of pupillometer data was conducted. Midline shift was correlated with objective pupillometry metrics including Neurological Pupil Index (NPi), pupil size, and anisocoria. Midline shift was measured for the patient's initial neuroimaging and with any defined neurological change. Spearman ρ was used for statistical analysis of correlations between pupillometer metrics and MLS measured at both the septum pellucidum and pineal gland. RESULTS: A total of 41 patients were included in the analysis; most were White (58.5%) and male (58.5%), with a mean (SD) age of 58.49 (16.92) years. Spearman ρ revealed statistically significant positive correlations between right pupil NPi and anisocoria with MLS, and significant negative correlations between left pupil NPi and pupil size with MLS. CONCLUSIONS: Results from this project are consistent with previous studies. Objective pupillometry continues to be a valuable component of a comprehensive neurological examination, because it has the ability to discern early and subtle changes in a patient's neurological status, leading to lifesaving interventions.
Primary Graft Dysfunction in Heart Transplant Recipients—Risk Factors and Longitudinal Outcomes
Authors: Smith Nicholas F. , Salehi Omran Sina , Genuardi Michael V. , Horn Edward T. , Kilic Arman , Sciortino Christopher M. , Keebler Mary E. , Kormos Robert L. , Hickey Gavin W.
Published: October 2021

Before the 33rd Annual International Society for Heart and Lung Transplantation conference, there was significant intercenter variability in definitions of primary graft dysfunction (PGD). The incidence, risk factors, and outcomes of consensus-defined PGD warrant further investigation. We retrospectively examined 448 adult cardiac transplant recipients at our institution from 2005 to 2017. Patient and procedural characteristics were compared between PGD cases and controls. Multivariable logistic regression was used to model PGD and immediate postoperative high-inotrope requirement for hypothesized risk factors. Patients were followed for a mean 5.3 years to determine longitudinal mortality. The incidence of PGD was 16.5%. No significant differences were found with respect to age, sex, race, body mass index, predicted heart mass mismatch, pretransplant amiodarone therapy, or pretransplant mechanical circulatory support (MCS) between recipients with PGD versus no PGD. Each 10 minute increase in ischemic time was associated with 5% greater odds of PGD (OR = 1.05 [95% CI, 1.00–1.10]; p = 0.049). Pretransplant MCS, predicted heart mass mismatch ≥30%, and pretransplant amiodarone therapy were associated with high-immediate postoperative inotropic requirement. The 30 day, 1 year, and 5 year mortality for patients with PGD were 28.4%, 38.0%, and 45.8%, respectively, compared with 1.9%, 7.1%, and 21.5% for those without PGD (log-rank, p < 0.0001). PGD heralded high 30 day, 1 year, and 5 year mortality. Pretransplant MCS, predicted heart mass mismatch, and amiodarone exposure were associated with high-inotrope requirement, while prolonged ischemic time and multiple perioperative transfusions were associated with consensus-defined PGD, which may have important clinical implications under the revised United Network for Organ Sharing allocation system.
Premature and Extracorporeal Life Support: Is it Time? A Systematic Review
Authors: Burgos Carmen Mesas , Frenckner Björn , Broman Lars Mikael
Published: October 2021

Early preterm birth < 34 gestational weeks (GA) and birth weight (BW) <2 kg are relative contraindications for extracorporeal membrane oxygenation (ECMO). However, with improved technology, ECMO is presently managed more safely and with decreasing complications. Thus, these relative contraindications may no longer apply. We performed a systematic review to evaluate the existing literature on ECMO in early and late (34–37 GA) prematurity focusing on survival to hospital discharge and the complication intracranial hemorrhage (ICH). Data sources: MEDLINE, PubMed, Web of Science, Embase, and the Cochrane Database. Only publications in the English language were evaluated. Of the 36 included studies, 23 were related to ECMO support for respiratory failure, 10 for cardiac causes, and four for congenital diaphragmatic hernia (CDH). Over the past decades, the frequency of ICH has declined (89–21%); survival has increased in both early prematurity (25–76%), and in CDH (33–75%), with outcome similar to late prematurity (48%). The study was limited by an inherent risk of bias from overlapping single-center and registry data. Both the risk of ICH and death have decreased in prematurely born treated with ECMO. We challenge the 34 week GA time limit for ECMO and propose an international task force to revise current guidelines. At present, gestational age < 34 weeks might no longer be considered a contraindication for ECMO in premature neonates.
Indwelling Central Venous Catheters Drive Bloodstream Infection During Veno-venous Extracorporeal Membrane Oxygenation Support
Authors: Manerikar Adwaiy , Watanabe Satoshi , Kandula Viswajit , Karim Azad , Thakkar Sanket , Saine Mark , Kim Samuel S. , Garza-Castillon Rafael , Odell David D. , Bharat Ankit , Kurihara Chitaru
Published: October 2021

Blood stream infection (BSI) is a potentially lethal complication in patients receiving extracorporeal membrane oxygenation (ECMO). It may be particularly common in patients with veno-venous ECMO due to their long hospitalization in the intensive care unit. Given that these patients have concurrent indwelling central venous catheters (CVC), it is unclear whether the ECMO circuit, CVC, or both, contribute to BSI. This study evaluated the risk factors associated with BSI in patients receiving veno-venous ECMO in a single institution study of 61 patients from 2016 through 2019. All ECMO catheters and the circuit oxygenator fluid were aseptically collected and analyzed for microorganisms at the time of decannulation. New BSI was diagnosed in 15 (24.6%) patients and increased mortality by threefold. None of the ECMO catheters or oxygenator fluid were culture positive. BSI increased with CVC use of over 8 days and was significantly lowered when CVC were exchanged by day 8 compared with patients with exchanges at later points (15.0% vs. 42.8%, p = 0.02). Median length of CVC use in the BSI-negative and BSI-positive group were 6.3 ± 5.0 and 9.4 ± 5.1, respectively (p = 0.04). In summary, BSI is a potentially lethal complication in patients receiving ECMO. Indwelling CVC, not the ECMO circuitry, is the likely contributor for BSI, and exchanging CVC by day 8 can reduce the incidence of BSI.