bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent fetal triploidy: is there a genetic cause?
Authors: Fontoura Oliveira Andreia , Torrão Maria Manuel , Nogueira Rosete , Ferreira Manuela
Published: March 2021

Triploidy is currently understood as a sporadic genetic disorder, with no recognisable risk of recurrence nor identifiable risk factors. In cases of triploidy, chances of thriving through the second trimester of fetal development are very slim, with most of these pregnancies ending as early miscarriage. We report a case of repeated triploid pregnancies in the same woman, from different fathers, achieving the second trimester of pregnancy; elective termination was decided in both cases, after an amniocentesis revealing a triploid karyotype. Both triploid pregnancies are described and compared; prenatal laboratorial markers, sonographic features, clinical course and pathological findings are analysed and matched with fetal autopsy and placental pathological study. Reported findings strongly point to recurrent triploidy of maternal origin, and so the possibility of a genetic predisposition should be considered. Investigation is required to assess the presence of an underlying genetic mechanism in this setting, thus enabling a better genetic/obstetric counselling.
Rhabdomyolysis secondary to severe tic fits
Authors: Au Ka Loong Kelvin , Chiu Shannon , Malaty Irene A
Published: March 2021

Tourette syndrome (TS) is a condition wherein motor and vocal tics occur, provoked by an urge, but often not able to be completely voluntarily controlled. Tics are known to cause physical and emotional risks to quality of life, and in rare extreme cases, may have permanent consequences. We report the first cases, to our knowledge, of rhabdomyolysis due to extreme tic fits in two distinct patients with TS. Both patients presented with severe tics, leading to elevated creatine kinase and a diagnosis of rhabdomyolysis requiring hospitalisation and intravenous fluids. Neither had neuroleptic malignant syndrome. One patient was on concurrent neuroleptic therapy, but his laboratory parameters improved when tics subsided despite continued neuroleptic use. Our cases highlight the potential complication of rhabdomyolysis secondary to severe tic fits independent of neuroleptic use.
Challenging retrovesical mass in men: report of a rare liposarcoma case with concurrent COVID-19 infection
Authors: Jamtani Indah , Nugroho Adianto , Rahadiani Nur , Manangka R Semuel W
Published: March 2021

We describe a case of retrovesical liposarcoma in a male patient with concurrent COVID-19. A 50-year-old man had lower urinary tract symptoms and dull pain along his right gluteus. Due to COVID-19 infection, management was delayed. During self-isolation, the patient developed urinary retention and his pain level was an eight on the Visual Analogue Scale. A urinary catheter and an epidural catheter were inserted without any difficulty. Abdominal-pelvic MRI revealed a retrovesical mass suspected of liposarcoma with clear borders from surrounding organs. Following two consecutive negative SARS-CoV-2 PCR tests, we proceeded with surgery. Histopathology was dedifferentiated liposarcoma. Postoperatively, the patient suffered reactivation of COVID-19, and he was eventually discharged after two consecutive negative results on the PCR test on Post Operative Day (POD)-10. Retrovesical dedifferentiated liposarcoma is rare and considered as high-grade liposarcoma. Although surgery may exacerbate COVID-19 infection, surgical resection of symptomatic high-grade sarcoma is prioritised and performed as soon as no infection detected.
Imaging as an alternate diagnostic modality in a presumptive case of abdominopelvic TB in a COVID-19 patient
Authors: Subramanian Niranjana , Sagili Haritha , Naik Parvathi , Durairaj Jayalakshmi
Published: March 2021

A 30-year-old, multiparous widow, with postpolio residual paralysis, presented with complaints of dull aching abdominal pain for 15 days. Ultrasound showed a mixed echogenic right adnexal mass with free fluid in the pelvis and abdomen. CT abdomen and pelvis revealed partially defined peripherally enhancing collection in lower abdomen and right adnexa suggestive of tubo-ovarian abscess. There was mild ileal wall thickening and few enlarged mesenteric lymph nodes. Ascitic fluid did not show acid fast bacilli and cultures were sterile. Extensive diagnostic laboratory work was done which was inconclusive. Diagnostic laparoscopy could not be performed due to non-availability of elective operation theatre in the COVID-19 pandemic. Presumptive extrapulmonary tuberculosis was clinically and radiologically diagnosed. She was started on daily anti tuberculosis treatment. This case shows us the importance of imaging as a diagnostic tool and as an alternative for laparoscopy in COVID-19 pandemic to diagnose abdomino-pelvic tuberculosis.
Improving estimates of the burden of severe wasting: analysis of secondary prevalence and incidence data from 352 sites
Authors: Isanaka Sheila , Andersen Christopher T , Cousens Simon , Myatt Mark , Briend André , Krasevec Julia , Hayashi Chika , Mayberry Amy , Mwirigi Louise , Guerrero Saul
Published: March 2021

Introduction

Estimates of incident cases of severe wasting among young children are not available for most settings but are needed for optimal planning of treatment programmes and burden estimation. To improve programme planning, global guidance recommends a single ‘incidence correction factor’ of 1.6 be applied to available prevalence estimates to account for incident cases. This study aimed to update estimates of the incidence correction factor to improve programme planning and inform the approach to burden estimation for severe wasting.

Methods

A global call was issued for secondary data from severe wasting treatment programmes including prevalence, population size, programme admission and programme coverage through a UNICEF-led effort. Site-specific incidence correction factors were calculated as the number of incident cases (annual programme admissions/programme coverage) divided by the number of prevalent cases (prevalence*population size). Estimates were aggregated by country, region and overall using inverse-variance weighted random-effects meta-analysis.

Results

We estimated incidence correction factors from 352 sites in 20 countries. Estimates aggregated by country ranged from 1.3 (Nigeria) to 30.1 (Burundi). Excluding implausible values, the overall incidence correction factor was 3.6 (95% CI 3.4 to 3.9).

Conclusion

Our results suggest that incidence correction factors vary between sites and that the burden of severe wasting will often be underestimated using the currently recommended incidence correction factor of 1.6. Application of updated incidence correction factors represents a simple way to improve programme planning when incidence data are not available and could inform the approach to burden estimation.
Applying natural language processing and machine learning techniques to patient experience feedback: a systematic review
Authors: Khanbhai Mustafa , Anyadi Patrick , Symons Joshua , Flott Kelsey , Darzi Ara , Mayer Erik
Published: March 2021

Objectives

Unstructured free-text patient feedback contains rich information, and analysing these data manually would require a lot of personnel resources which are not available in most healthcare organisations.To undertake a systematic review of the literature on the use of natural language processing (NLP) and machine learning (ML) to process and analyse free-text patient experience data.

Methods

Databases were systematically searched to identify articles published between January 2000 and December 2019 examining NLP to analyse free-text patient feedback. Due to the heterogeneous nature of the studies, a narrative synthesis was deemed most appropriate. Data related to the study purpose, corpus, methodology, performance metrics and indicators of quality were recorded.

Results

Nineteen articles were included. The majority (80%) of studies applied language analysis techniques on patient feedback from social media sites (unsolicited) followed by structured surveys (solicited). Supervised learning was frequently used (n=9), followed by unsupervised (n=6) and semisupervised (n=3). Comments extracted from social media were analysed using an unsupervised approach, and free-text comments held within structured surveys were analysed using a supervised approach. Reported performance metrics included the precision, recall and F-measure, with support vector machine and Naïve Bayes being the best performing ML classifiers.

Conclusion

NLP and ML have emerged as an important tool for processing unstructured free text. Both supervised and unsupervised approaches have their role depending on the data source. With the advancement of data analysis tools, these techniques may be useful to healthcare organisations to generate insight from the volumes of unstructured free-text data.
Google translate in healthcare: preliminary evaluation of transcription, translation and speech synthesis accuracy
Authors: Birkenbeuel Jack , Joyce Helen , Sahyouni Ronald , Cheung Dillon , Maducdoc Marlon , Mostaghni Navid , Sahyouni Sammy , Djalilian Hamid , Chen Jefferson , Lin Harrison
Published: March 2021

Objective

To assess the ability of Google Translate (GT) to accurately interpret single sentences and series of sentences commonly used in healthcare encounters from English to Spanish.

Design

English-speaking volunteers used GT to interpret a list of 83 commonly used sentences and series of sentences of different lengths containing both medical and non-medical terminology. A certified medical interpreter evaluated whether the meaning of these sentences was preserved.

Participants

Eighteen English-speaking subjects (nine males and nine females), with a mean age of 36 years, volunteered for this study to read sentences.

Main outcome measures

The accuracy of GTs (1) real-time voice recognition (ie, transcription) of English sentences, (2) real-time translation of these transcribed English sentences to Spanish, and (3) GTs speech synthesis ability to preserve the meaning of spoken English sentences after translation to Spanish.

Results

Speech synthesis accuracy, with preservation of the original English-spoken sentence(s), was 89.4% for single sentences with ≤8 words; 90.6% for single sentences with >8 words; 52.2% for two sentences and 26.6% for three sentences. Furthermore, the number of transcription and translation errors per sentence(s) significantly increased with the number of sentences (p<0.05).

Conclusions

Despite the fact that GTs accuracy was widely variable and dependent on the length of the spoken sentence(s), GT is readily accessible, has no associated monetary costs, and offers nearly immediate interpretation services. As such, it has the potential to routinely facilitate effective one-way oral communication between English-speaking physicians and Spanish-speaking patients with limited English proficiency.
Deep learning model to predict the need for mechanical ventilation using chest X-ray images in hospitalised patients with COVID-19
Authors: Kulkarni Anoop R , Athavale Ambarish M , Sahni Ashima , Sukhal Shashvat , Saini Abhimanyu , Itteera Mathew , Zhukovsky Sara , Vernik Jane , Abraham Mohan , Joshi Amit , Amarah Amatur , Ruiz Juan , Hart Peter D , Kulkarni Hemant
Published: March 2021

Objectives

There exists a wide gap in the availability of mechanical ventilator devices and their acute need in the context of the COVID-19 pandemic. An initial triaging method that accurately identifies the need for mechanical ventilation in hospitalised patients with COVID-19 is needed. We aimed to investigate if a potentially deteriorating clinical course in hospitalised patients with COVID-19 can be detected using all X-ray images taken during hospitalisation.

Methods

We exploited the well-established DenseNet121 deep learning architecture for this purpose on 663 X-ray images acquired from 528 hospitalised patients with COVID-19. Two Pulmonary and Critical Care experts blindly and independently evaluated the same X-ray images for the purpose of validation.

Results

We found that our deep learning model predicted the need for mechanical ventilation with a high accuracy, sensitivity and specificity (90.06%, 86.34% and 84.38%, respectively). This prediction was done approximately 3 days ahead of the actual intubation event. Our model also outperformed two Pulmonary and Critical Care experts who evaluated the same X-ray images and provided an incremental accuracy of 7.24%–13.25%.

Conclusions

Our deep learning model accurately predicted the need for mechanical ventilation early during hospitalisation of patients with COVID-19. Until effective preventive or treatment measures become widely available for patients with COVID-19, prognostic stratification as provided by our model is likely to be highly valuable.
Risk of active tuberculosis in migrants diagnosed with cancer: a retrospective cohort study in British Columbia, Canada
Authors: Kumar Divjot S , Ronald Lisa A , Romanowski Kamila , Rose Caren , Shulha Hennady P , Cook Victoria J , Johnston James C
Published: March 2021

Objectives

To describe the association between types of cancer and active tuberculosis (TB) risk in migrants. Additionally, in order to better inform latent TB infection (LTBI) screening protocols, we assessed proportion of active TB cases potentially preventable through LTBI screening and treatment in migrants with cancer.

Design

Population-based, retrospective cohort study.

Setting

British Columbia (BC), Canada.

Participants

1 000 764 individuals who immigrated to Canada from 1985 to 2012 and established residency in BC at any point up to 2015.

Primary and secondary outcome measures

Using linked health administrative databases and disease registries, data on demographics, comorbidities, cancer type, TB exposure and active TB diagnosis were extracted. Primary outcomes included: time to first active TB diagnoses, and risks of active TB following cancer diagnoses which were estimated using Cox extended hazard regression models. Potentially preventable TB was defined as active TB diagnosed >6 months postcancer diagnoses.

Results

Active TB risk was increased in migrants with cancer ((HR (95% CI)) 2.5 (2.0 to 3.1)), after adjustment for age, sex, TB incidence in country of origin, immigration classification, contact status and comorbidities. Highest risk was observed with lung cancer (HR 11.2 (7.4 to 16.9)) and sarcoma (HR 8.1 (3.3 to 19.5)), followed by leukaemia (HR 5.6 (3.1 to 10.2)), lymphoma (HR 4.9 (2.7 to 8.7)) and gastrointestinal cancers (HR 2.7 (1.7 to 4.4)). The majority (65.9%) of active TB cases were diagnosed >6 months postcancer diagnosis.

Conclusion

Specific cancers increase active TB risk to varying degrees in the migrant population of BC, with approximately two-thirds of active TB cases identified as potentially preventable.
Real-world challenges for patients with breast cancer in sub-Saharan Africa: a retrospective observational study of access to care in Ghana, Kenya and Nigeria
Authors: Twahir Majid , Oyesegun Razaq , Yarney Joel , Gachii Andrew , Edusa Clement , Nwogu Chukwumere , Mangutha Gitangu , Anderson Philip , Benjamin Emmanuel , Müller Borna , Ngoh Charles
Published: March 2021

Objective

To evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa.

Design

Data were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards.

Setting

Six tertiary care institutions in Ghana, Kenya and Nigeria were included.

Participants

Health records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria.

Interventions

As directed by the treating physician.

Outcome measures

Parameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns.

Results

Use of mammography or breast ultrasonography was <45% in all three countries. Across the three countries, 78%–88% of patients completed tests for hormone receptors and human epidermal growth factor receptor 2 (HER2). Most patients underwent mastectomy (64%–67%) or breast-conserving surgery (15%–26%). Turnaround times for key procedures, such as pathology, surgery and systemic therapy, ranged from 1 to 5 months. In Ghana and Nigeria, most patients (87%–93%) paid for diagnostic tests entirely OOP versus 30%–32% in Kenya. Similarly, proportions of patients paying OOP only for treatments were high: 45%–79% in Ghana, 8%–20% in Kenya and 72%–89% in Nigeria. Among patients receiving HER2-targeted therapy, the average number of cycles was five for those paying OOP only versus 14 for those with some insurance coverage.

Conclusions

Patients with breast cancer treated in tertiary facilities in sub-Saharan Africa lack access to timely diagnosis and modern systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their healthcare and were more likely to be employed and have secondary or postsecondary education. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.
Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study
Authors: Shetty Siddesh Sitaram , Moray Kusum Venkobrao , Chaurasia Himanshu , Joshi Beena Nitin
Published: March 2021

Objective

Postpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India.

Design

Health system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities.

Settings

Four public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing.

Outcome measures

Unit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017–2018.

Results

Medical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596).

Conclusions

Atonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state’s annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.
WeChat-based vestibular rehabilitation for patients with chronic vestibular syndrome: protocol for a randomised controlled trial
Authors: Wu Peixia , Wan Yafang , Zhuang Yu , Wang Chennan , Xi Shuxin , Zhu Hui
Published: March 2021

Introduction

Dizziness is one of the most common symptoms seen in chronic vestibular syndrome, which has been linked to an increased risk of falls, substantial disability and negative psychological consequences. Recent evidence demonstrated that vestibular rehabilitation therapy (VRT) is effective for treating chronic vestibular symptoms. However, the delivery of VRT remains challenging because of lack of facility, insufficient qualified physiotherapist resources, as well as being in the actual situation of the pandemic. WeChat, the most widely used mobile app in China, offers a more viable way of delivering VRT than traditional office-based approaches do. This study aimed to evaluate the effectiveness of the WeChat-VRT programme for patients with chronic vestibular syndrome.

Methods and analysis

This is a parallel-group, assessor-blinded randomised controlled trial. Fifty patients who experienced chronic vestibular symptoms longer than 3 months will be randomised into either the WeChat-VRT group or the usual care (UC) group. Participants in the WeChat-VRT group will receive 8-week VRT mainly through the WeChat app. Participants in the UC group will receive once-weekly VRT in the clinic for 8 weeks and remaining time home-based exercise. Outcome assessments will take place at baseline and at the 8th, 12th and 24th weeks after randomisation. The primary outcome will be the change from baseline to the eighth week on the patients’ functional improvements quantified by the Functional Gait Assessment (FGA). The secondary outcomes will include dynamic balance function, emotional well-being, and vestibular activity and participation level. Intention-to-treat analysis will be performed using generalised estimation equation modelling.

Ethics and dissemination

The trial has been reviewed and approved by the Institutional Review Board of Eye and Ear Nose Throat Hospital of Fudan University (reference number 2017047/1). The study findings will be disseminated via peer-reviewed journals and conferences.

Trial registration number

ChiCTR2000029457; Pre-results.
Mixed-method study to assess the feasibility, acceptability and early effectiveness of the Hospital to Home programme for follow-up of high-risk newborns in a rural district of Central Uganda: a study protocol
Authors: Kabugo Daniel , Nakamura Heidi , Magnusson Brooke , Vaughan Madeline , Niyonshaba Beatrice , Nakiganda Cornety , Otai Christine , Haddix-McKay Kimber , Seela Margaret , Nankabala Joyce , Nakakande Josephine , Ssekidde Moses , Tann Cally J , al-Haddad Benjamin J S , Nyonyintono James , Mubiri Paul , Waiswa Peter , Paudel Mohan
Published: March 2021

Introduction

A follow-up programme designed for high-risk newborns discharged from inpatient newborn units in low-resource settings is imperative to ensure these newborns receive the healthiest possible start to life. We aim to assess the feasibility, acceptability and early outcomes of a discharge and follow-up programme, called Hospital to Home (H2H), in a neonatal unit in central Uganda.

Methods and analysis

We will use a mixed-methods study design comparing a historical cohort and an intervention cohort of newborns and their caregivers admitted to a neonatal unit in Uganda. The study design includes two main components. The first component includes qualitative interviews (n=60 or until reaching saturation) with caregivers, community health workers called Village Health Team (VHT) members and neonatal unit staff. The second component assesses and compares outcomes between a prospective intervention cohort (n=100, born between July 2019 and September 2019) and a historical cohort (n=100, born between July 2018 and September 2018) of infants. The historical cohort will receive standard care while the intervention cohort will receive standard care plus the H2H intervention. The H2H intervention comprises training for healthcare workers on lactation, breast feeding and neurodevelopmentally supportive care, including cue-based feeding, and training to caregivers on recognition of danger signs and care of their high-risk infants. Infants and their families receive home visits until 6 months of age, or longer if necessary, by specially trained VHTs. Quantitative data will be analysed using descriptive statistics and regression analysis. All results will be stratified by cohort group. Qualitative data will be analysed guided by Braun and Clarke’s thematic analysis technique.

Ethics and dissemination

This study protocol was approved by the relevant Ugandan ethics committees. All participants will provide written informed consent. We will disseminate through peer-reviewed publications and key stakeholders and public engagement.

Trial registration number

ISRCTN51636372; Pre-result.
High-dose vitamin D supplementation to prevent prostate cancer progression in localised cases with low-to-intermediate risk of progression on active surveillance (ProsD): protocol of a phase II randomised controlled trial
Authors: Nair-Shalliker Visalini , Smith David P , Gebski Val , Patel Manish I , Frydenberg Mark , Yaxley John W , Gardiner Robert , Espinoza David , Kimlin Michael G , Fenech Michael , Gillatt David , Woo Henry , Armstrong Bruce K , Rasiah Krishan , Awad Nader , Symons James , Gurney Howard
Published: March 2021

Introduction

Active surveillance (AS) for patients with prostate cancer (PC) with low risk of PC death is an alternative to radical treatment. A major drawback of AS is the uncertainty whether a patient truly has low risk PC based on biopsy alone. Multiparametric MRI scan together with biopsy, appears useful in separating patients who need curative therapy from those for whom AS may be safe. Two small clinical trials have shown short-term high-dose vitamin D supplementation may prevent PC progression. There is no substantial evidence for its long-term safety and efficacy, hence its use in the care of men with PC on AS needs assessment. This protocol describes the ProsD clinical trial which aims to determine if oral high-dose vitamin D supplementation taken monthly for 2 years can prevent PC progression in cases with low-to-intermediate risk of progression.

Method and analysis

This is an Australian national multicentre, 2:1 double-blinded placebo-controlled phase II randomised controlled trial of monthly oral high-dose vitamin D supplementation (50 000 IU cholecalciferol), in men diagnosed with localised PC who have low-to-intermediate risk of disease progression and are being managed by AS. This trial will assess the feasibility, efficacy and safety of supplementing men with an initial oral loading dose of 500 000 IU cholecalciferol, followed by a monthly oral dose of 50 000 IU during the 24 months of AS. The primary trial outcome is the commencement of active therapy for clinical or non-clinical reason, within 2 years of AS.

Ethics and dissemination

This trial is approved by Bellberry Ethics Committee (2016-06-459). All results will be reported in peer-reviewed journals.

Trial registration number

ACTRN12616001707459.
Evaluating the contributions of strategies to prevent SARS-CoV-2 transmission in the healthcare setting: a modelling study
Authors: Qiu Xueting , Miller Joel C , MacFadden Derek R , Hanage William P
Published: March 2021

Introduction

Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic/presymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE), testing and other approaches to prevent these events is unclear, especially in light of ongoing limited resources.

Methods

Using stochastic simulations with a susceptible-exposed-infected-recovered dynamic model, we quantified and compared the impacts of PPE use, patient and HCWs surveillance testing and subcohorting strategies.

Results

In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic/presymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection. Importantly, we found that creating smaller patient/HCW-interaction subcohorts can provide additional resilience to outbreak development with limited resources.

Conclusion

These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.
Digital health literacy intervention to support maternal, child and family health in primary healthcare settings of Pakistan during the age of coronavirus: study protocol for a randomised controlled trial
Authors: Jafree Sara Rizvi , Bukhari Nadia , Muzamill Anam , Tasneem Faiza , Fischer Florian
Published: March 2021

Introduction

There is a need to continue primary healthcare services through digital communication for disadvantaged women living in underdeveloped areas of Pakistan, especially in the age of the coronavirus pandemic, social distancing and lockdown of communities. This project will be the first of its kind in aiming to implement a digital health literacy intervention, using smartphone and internet, to disadvantaged women through female community healthcare workers. Improved health literacy in women of reproductive years is known to promote maternal, child and family health overall.

Methods and analysis

The study will include a baseline survey, a pre- and post-test survey and a 3-month lasting intervention on (1) hygiene and prevention and (2) coronavirus awareness and prevention. Women of reproductive years will be sampled from disadvantaged areas across the four provinces of Pakistan (Baluchistan, Khyber Pakhtunkhwa, Punjab and Sindh), and the selection criteria will be poor, semiliterate or illiterate, belonging to underdeveloped neighbourhoods devoid of universal healthcare coverage and dependent on free primary health services. A target of 1000 women will comprise the sample, with 500 women each assigned randomly to the intervention and control groups. Analysis of variance and multivariate analysis will be used for analysing the intervention’s effects compared with the control group.

Ethics and dissemination

Ethics approval for this study has been received from the Internal Review Board of the Forman Christian College University (reference number: IRB-252/06-2020). Results will be published in academic journals of repute and dissemination to the international scientific community and stakeholders will also be planned through workshops.

Trial registration number

NCT04603092.
Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study
Authors: Eng Chee Wen , Tuot Sovannary , Chann Navy , Chhoun Pheak , Mun Phalkun , Yi Siyan
Published: March 2021

Objective

To estimate the prevalence of HIV testing and examine factors associated with recent HIV testing among people who use drugs (PWUD) in Cambodia.

Design

Cross-sectional study.

Setting

Twelve major provinces with a high burden of HIV and drug use in Cambodia.

Participants

This study included 1677 PWUD recruited using a peer-based social network recruitment method. Participants’ selection criteria included being at least 18 years old and using any illicit drugs via any administration routes in the past 12 months.

Primary outcome measure

Recent HIV testing, defined as having an HIV test in the past 6 months.

Results

The median age of the participants was 28 (IQR 22–34) years, and 56.6% were men. The prevalence of lifetime and recent HIV testing was 70.7% and 42.9%, respectively. After adjustment in multivariable logistic regression analysis, recent HIV testing remained positively associated with being female (adjusted OR (AOR) 1.55, 95% CI 1.18 to 2.04) or third gender identity (AOR 2.06, 95% CI 1.11 to 3.80), having ever been to a drug rehabilitation centre (AOR 1.60, 95% CI 1.13 to 2.29), having used any HIV services in the past 6 months (AOR 7.37, 95% CI 5.61 to 9.69), having received HIV education in the past 3 months (AOR 3.40, 95% CI 2.63 to 4.40) and having self-perception of higher HIV risk (AOR 1.81, 95% CI 1.19 to 2.73).

Conclusions

Recent HIV test uptake among PWUD in Cambodia was suboptimal. This study highlights the roles of outreach HIV education and services in promoting regular HIV testing among PWUD. Strengthening the coordinated effort of government agencies and local civil society organisations to prioritise expanding community-based peer-driven interventions to reach out to this hidden population is warranted.
Discrete choice experiment (DCE) to quantify the influence of trial features on the decision to participate in cystic fibrosis (CF) clinical trials
Authors: Dobra Rebecca Anne , Boeri Marco , Elborn Stuart , Kee Frank , Madge Susan , Davies Jane C
Published: March 2021

Introduction

Engaging people with cystic fibrosis (CF) in clinical trials is critical to improving outcomes for this fatal disease. Following extensive exploration of engagement in CF trials we believe six key concepts require a quantitative understanding of their influence in the current CF trials landscape including how controversial issues like placebos, washouts, stipend provision and location of trial visits are viewed by the CF community and how these might be modified depending on the type of medicine being investigated and the mechanism of access to the drug on trial completion.

Methods and analysis

We have designed and will administer an online discrete choice experiment to elicit and quantify preferences of people with CF for these trials’ attributes and estimate the relative importance of an attribute when choosing to participate in a trial. The cross-sectional data generated will be explored using conditional multinomial logit model. Mixed logit models such as the random-parameters logit and a latent class models will be used to explore preference heterogeneity. To determine the relative importance of an attribute, the difference between the attribute level with the highest preference weight and the level with the lowest preference weight will be calculated.

Ethics and dissemination

Imperial College London Joint Research Compliance Office has granted ethical approval for this study. Patient consent will be sought following full explanation. No identifying information will be collected. Dissemination will be via international conferences, peer-review publication and patient accessible forums. Major CF trials networks have agreed to incorporate our findings into their review process, meaning our results can realistically influence and optimise CF trial delivery.

PROSPERO registration number

CRD42020184886.
Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
Authors: Brissman Markus , Beamish Andrew J , Olbers Torsten , Marcus Claude
Published: March 2021

Objective

The study aimed to investigate the heterogeneity of weight loss 5 years after Roux-en-Y gastric bypass (RYGB) and the association with cardiometabolic health as well as to model prediction estimates of surgical treatment failure.

Design

Retrospective analysis of prospectively collected data from the Scandinavian Obesity Surgery Registry (SOReg).

Setting

29 surgical units from the whole of Sweden contributed data. Inclusion was restricted to surgical units with a retention rate of >60% five years postsurgery.

Participants

10 633 patients were extracted from SOReg. In total 5936 participants were included in the final sample, 79.1% females. The mean age of participants before surgery was 39.4±9 years and mean body mass index (BMI) 42.9±5.1. 2322 were excluded (death before the 5-year follow-up (n=148), other types of surgery or reoperations (n=637), age at surgery <18 or >55 years (n=1329), presurgery BMI <35 kg/m2(n=208)). In total, 2375 (29%) of eligible individuals were lost to the 5-year follow-up.

Main outcome

The occurrence of surgical treatment failure 5 years after surgery was based on the three previously published definitions: per cent excess BMI loss <50%, total weight loss <20% or BMI >35 where initial BMI was <50, or >40 where initial BMI was >50. In addition, we report the association between surgical treatment failure and biochemical markers of obesity-related comorbidity. We also developed predictive models to identify patients with a high risk of surgical treatment failure 5 years postsurgery.

Results

In total, 23.1% met at least one definition of surgical treatment failure at year 5 which was associated with (adjusted OR) with 95% CI): type 2 diabetes (T2D, OR 2.1; 95% CI 1.6 to 2.7), dyslipidaemia (OR 1.8; 95% CI 1.6 to 2.1) and hypertension (OR 1.9; 95% CI 1.6 to 2.2). Surgical treatment failure at 5 years was predicted by combined demographic and anthropometric measures from baseline, 1 and 2 years postsurgery (area under the curve=0.874).

Conclusion

Laparoscopic RYGB leads to a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure, which was associated with a greater risk of relapse and a higher incidence of T2D, dyslipidaemia and hypertension 5 years after surgery. Poor initial weight loss and early weight regain are strong predictors of long-term treatment failure and may be used for early identification of patients who require additional weight loss support.
Rapamycin enhances BCG-specific γδ T cells during intravesical BCG therapy for non-muscle invasive bladder cancer: a randomized, double-blind study
Authors: Ji Niannian , Mukherjee Neelam , Reyes Ryan M , Gelfond Jonathan , Javors Martin , Meeks Joshua J. , McConkey David J , Shu Zhen-Ju , Ramamurthy Chethan , Dennett Ryan , Curiel Tyler J , Svatek Robert S
Published: March 2021

Background

Although intravesical BCG is the standard treatment of high-grade non-muscle invasive bladder cancer (NMIBC), response rates remain unsatisfactory. In preclinical models, rapamycin enhances BCG vaccine efficacy against tuberculosis and the killing capacity of γδ T cells, which are critical for BCG’s antitumor effects. Here, we monitored immunity, safety, and tolerability of rapamycin combined with BCG in patients with NMIBC.

Methods

A randomized double-blind trial of oral rapamycin (0.5 or 2.0 mg daily) versus placebo for 1 month was conducted in patients with NMIBC concurrently receiving 3 weekly BCG instillations (NCT02753309). The primary outcome was induction of BCG-specific γδ T cells, measured as a percentage change from baseline. Post-BCG urinary cytokines and immune cells were examined as surrogates for local immune response in the bladder. Secondary outcomes measured were adverse events (AEs) and tolerability using validated patient-reported questionnaires.

Results

Thirty-one patients were randomized (11 placebo, 8 rapamycin 2.0 mg, and 12 rapamycin 0.5 mg). AEs were similar across groups and most were grade 1–2. One (12.5%) patient randomized to 2.0 mg rapamycin was taken off treatment due to stomatitis. No significant differences in urinary symptoms, bowel function, or bother were observed between groups. The median (IQR) percentage change in BCG-specific γδ T cells from baseline per group was as follows: −26% (−51% to 24%) for placebo, 9.6% (−59% to 117%) for rapamycin 0.5 mg (versus placebo, p=0.18), and 78.8% (−31% to 115%) for rapamycin 2.0 mg (versus placebo, p=0.03). BCG-induced cytokines showed a progressive increase in IL-8 (p=0.02) and TNF-α (p=0.04) over time for patients on rapamycin 2.0 mg, whereas patients receiving placebo had no significant change in urinary cytokines. Compared with placebo, patients receiving 2.0 mg rapamycin had increased urinary γδ T cells at the first week of BCG (p=0.02).

Conclusions

Four weeks of 0.5 and 2.0 mg oral rapamycin daily is safe and tolerable in combination with BCG for patients with NMIBC. Rapamycin enhances BCG-specific γδ T cell immunity and boosts urinary cytokines during BCG treatment. Further study is needed to determine long-term rapamycin safety, tolerability and effects on BCG efficacy.
Electrocardiographic features of immune checkpoint inhibitor associated myocarditis
Authors: Zlotoff Daniel A , Hassan Malek Z O , Zafar Amna , Alvi Raza M , Awadalla Magid , Mahmood Syed S , Zhang Lili , Chen Carol L , Ederhy Stephane , Barac Ana , Banerji Dahlia , Jones-O'Connor Maeve , Murphy Sean P , Armanious Merna , Forrestal Brian J , Kirchberger Michael C , Coelho-Filho Otavio R , Rizvi Muhammad A , Sahni Gagan , Mandawat Anant , Tocchetti Carlo G , Hartmann Sarah , Gilman Hannah K , Zatarain-Nicolás Eduardo , Mahmoudi Michael , Gupta Dipti , Sullivan Ryan , Ganatra Sarju , Yang Eric H , Heinzerling Lucie M , Thuny Franck , Zubiri Leyre , Reynolds Kerry L , Cohen Justine V , Lyon Alexander R , Groarke John , Thavendiranathan Paaladinesh , Nohria Anju , Fradley Michael G , Neilan Tomas G
Published: March 2021

Background

Myocarditis is a highly morbid complication of immune checkpoint inhibitor (ICI) use that remains inadequately characterized. The QRS duration and the QTc interval are standardized electrocardiographic measures that are prolonged in other cardiac conditions; however, there are no data on their utility in ICI myocarditis.

Methods

From an international registry, ECG parameters were compared between 140 myocarditis cases and 179 controls across multiple time points (pre-ICI, on ICI prior to myocarditis, and at the time of myocarditis). The association between ECG values and major adverse cardiac events (MACE) was also tested.

Results

Both the QRS duration and QTc interval were similar between cases and controls prior to myocarditis. When compared with controls on an ICI (93±19 ms) or to baseline prior to myocarditis (97±19 ms), the QRS duration prolonged with myocarditis (110±22 ms, p<0.001 and p=0.009, respectively). In contrast, the QTc interval at the time of myocarditis (435±39 ms) was not increased compared with pre-myocarditis baseline (422±27 ms, p=0.42). A prolonged QRS duration conferred an increased risk of subsequent MACE (HR 3.28, 95% CI 1.98 to 5.62, p<0.001). After adjustment, each 10 ms increase in the QRS duration conferred a 1.3-fold increase in the odds of MACE (95% CI 1.07 to 1.61, p=0.011). Conversely, there was no association between the QTc interval and MACE among men (HR 1.33, 95% CI 0.70 to 2.53, p=0.38) or women (HR 1.48, 95% CI 0.61 to 3.58, p=0.39).

Conclusions

The QRS duration is increased in ICI myocarditis and is associated with increased MACE risk. Use of this widely available ECG parameter may aid in ICI myocarditis diagnosis and risk-stratification.
Conference panels: do they reflect the diversity of the NHS workforce?
Authors: Prathivadi Bhayankaram Kethaki , Prathivadi Bhayankaram Nuthana
Published: March 2021

Background

The number of female and black, Asian and minor ethnicity (BAME) healthcare professionals has significantly increased over the last few decades. While this highlights the National Health Service (NHS) workforce as diverse and inclusive, most senior managers and conference panellists remain mainly men from Caucasian backgrounds.

Methods

We reviewed all publicly available data for major Royal College conferences in the UK from 2015 to 2019 to examine how many of the panellists were men or women and how many were Caucasian or BAME.

Results

Our first finding was that publicly available data were available for only 20 out of 70 conferences (29%). At 60% (n=12) of conferences, there were a predominance of male speakers. The median percentage of female speakers remained between 35% and 46%. There were no all-male panels. At 20% (n=4) of conferences in the sample, there were no BAME speakers. The median percentage of BAME speakers remained between 9% and 18%.

Conclusion

Conference panels do not yet reflect the diversity of the NHS workforce. We all have a duty to promote inclusivity and diversity in medicine. One way to do this is via conferences, through appropriate actions by conference organisers, panellists and delegates.
Precession of timelike bound orbits in Kerr spacetime
Authors: Bambhaniya Parth , Solanki Divyesh N. , Dey Dipanjan , Joshi Ashok B. , Joshi Pankaj S. , Patel Vishva
Published: March 2021

Astrometric observations of S-stars provide a unique opportunity to probe the nature of Sagittarius-A* (Sgr-A*). In view of this, it has become important to understand the nature and behavior of timelike bound trajectories of particles around a massive central object. It is known now that whereas the Schwarzschild black hole does not allow the negative precession for the S-stars, the naked singularity spacetimes can admit the positive as well as negative precession for the bound timelike orbits. In this context, we study the perihelion precession of a test particle in the Kerr spacetime geometry. Considering some approximations, we investigate whether the timelike bound orbits of a test particle in Kerr spacetime can have negative precession. In this paper, we only consider low eccentric timelike equatorial orbits. With these considerations, we find that in Kerr spacetimes, negative precession of timelike bound orbits is not allowed.
Geometrically Nonlinear Dynamic Response of Perforated Plates by Modified Differential Quadrature Method
Authors: Wang Chen , Liu Rongqiang , Huang Jiangping
Published: March 2021

The paper presents a modified differential quadrature (MDQ) method to investigate the dynamic response of perforated plates with elastically restrained edges under uniaxial impact compressive load. The perforated plate is divided into several separate plate elements that can be connected by using penalty function method (PFM) to ensure continuity along the shared edges. The in-plane stress distribution of the plate under the mechanical edge loading is determined by the pre-buckling analysis. To analyze the effect of elastically restrained edges on the dynamic response of perforated plates, artificial springs imposed for the edges are considered in the governing equilibrium equations. Verification analysis is carried out to demonstrate the efficiency and accuracy of the proposed method by comparing the results obtained with those available in the literature. Finally, the various effects of initial imperfection, rotational restrained stiffness, hole size and location, and shear load, on the dynamic response of perforated plates are investigated. The results show that the dynamic buckling load of perforated plates is significantly influenced by the rotational restraint stiffness, hole size and shear load as well as the initial geometric imperfection, whereas the effect of hole location can be neglected in the analysis of dynamic buckling of plates. Additionally, the results predicted by the proposed method can correlate well with the available numerical results.
Growth functions of lie algebras associated with associative algebras
Authors: Alahmadi Adel , Alharthi Fawziah
Published: March 2021

Let [Formula: see text] be a finitely generated associative algebra over a field [Formula: see text] of characteristic [Formula: see text] and let [Formula: see text] be its associated Lie algebra. In this paper, we investigate relations between the growth functions of [Formula: see text] and the Lie algebra [Formula: see text]. We prove that if A is generated by a finite collection of nilpotent elements, then the growth functions are asymptotically equivalent.