bluuebunny/crossref_metadata_2025 huggingface dataset:
Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction
Authors: Sheikh Muhammad A. , Ngendahimana David , Deo Salil V. , Raza Sajjad , Altarabsheh Salah E. , Reed Grant W. , Kalra Ankur , Cmolik Brian , Kapadia Samir , Eagle Kim A.
Published: January 2021

Objective

We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission.

Methods

We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC−). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission.

Results

A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37–1.48) and heart failure (RR = 5.8, 95% CI: 5.5–6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC− patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82–0.96; P < 0.001).

Conclusion

In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.
The prevalence, management and outcomes of coronary artery perforations during percutaneous coronary intervention in patients with or without acute coronary syndromes
Authors: Simsek Ersin C. , Kiris Tuncay
Published: January 2021

Background

Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention (PCI). The aim of this study was to compare early and late clinical outcomes of CAP in patients with or without acute coronary syndromes (ACS).

Method

A retrospective review was made of the procedural records of 15 878 patients who underwent PCI at two large tertiary centers between January 2012 and December 2018. A total of 51 (0.32 %) CAP cases were identified.

Results

Of the 51 CAP cases, 26 (51.0%) patients had ACS and 25 (49%) patients had stable coronary artery disease (CAD). The major cause of perforation was stenting (43%). Cardiac tamponade was more frequent in the ACS group than stable CAD group (34.6 vs. 8%; P = 0.024). Kaplan–Meier analysis showed that the overall 30-day cardiovascular mortality rate was higher in patients with ACS than stable CAD (23.1 vs. 0%; P = 0.011). At the 3-year follow-up examination, no statistically significant difference was determined between the two groups in respect of all-cause mortality (36.1 vs. 28.4%; P = 0.262). Multivariable Cox regression analysis demonstrated left ventricular ejection fraction (hazard ratio, 0.94; 95% CI, 0.89–0.99; P = 0.033) but not ACS at presentation (hazard ratio, 1.39; 95% CI, 0.37–5.20; P = 0.628) as a predictor of mortality at 3 years.

Conclusions

Early clinical outcomes following CAP, including cardiac tamponade and 30-day cardiovascular mortality, were significantly worse in patients with ACS compared to stable CAD.
Systematic review and meta-analysis of the incidence of recurrence of spontaneous coronary artery dissection
Authors: Mridha Naim , Millhouse James , Oldfield Kieran , Adams Cobi , Hughes Ian , Singh Kuljit
Published: January 2021

Aim

Recurrence is a well-established complication of spontaneous coronary artery dissection (SCAD). However, the exact incidence and correlates of recurrence are unknown. We, therefore, performed a systematic review and meta-analysis to determine and consolidate the evidence on the global incidence of SCAD recurrence.

Methods

A comprehensive search of the four major databases (EMBASE, OVID Medline, PubMed and Google Scholar) was performed from their inception to 17 January 2019. We included original research studies, recruiting ≥10 participants, with ≥12 months follow-up that reported data on recurrence in patients with SCAD.

Results

Out of 556 studies searched, 19 cohorts (1538 SCAD patients) were included in the analysis. There were 153 cases of de novo recurrence over a mean follow-up period of 31.2 months (95% confidence interval, 25–41 months). Type 1, 2 and 3 SCAD was noted in 33.2, 73.2 and 5.3%, respectively. The involved coronary artery was LMCA, LAD, RCA, LCx and multi-vessel CAD respectively in 3.5%, 53.4%, 19.8%, 20.4% and 12.6% of cases. The overall SCAD de novo recurrence was 7% (ES 0.07, 95% confidence interval, 0.04–0.10, I
2 = 65.3%). On meta-regression, we found discharge medications at index admission, including β-blockers, ACE inhibitors, statins, as well as baseline cardiac risk factors, did not correlate with recurrence.

Conclusion

SCAD recurrence is common, occurring in 7% of patients over medium-term follow up. No specific medications at discharge were found to reduce recurrence. Further long-term and prospective data are required.
C-reactive protein-to-serum albumin ratio as a novel predictor of long-term outcomes in coronary artery disease patients who have undergone percutaneous coronary intervention: analysis of a real-world retrospective cohort study
Authors: Liu Zhi-Yu , Tang Jun-Nan , Cheng Meng-Die , Jiang Li-Zhu , Guo Qian-Qian , Zhang Jian-Chao , Zhang Zeng-Lei , Song Feng-Hua , Wang Kai , Fan Lei , Yue Xiao-Ting , Bai Yan , Dai Xin-Ya , Zheng Ru-Jie , Zheng Ying-Ying , Zhang Jin-Ying
Published: January 2021

Background

C-reactive protein (CRP) has been proposed as a contributor to the pathogenesis of coronary artery disease (CAD) and inflammatory reactions, which are associated with a decrease in serum albumin, and it has been reported that the CRP-to-serum albumin ratio (CAR) can predict CAD severity in inpatient ischemic cardiomyopathy (ICM) patients. However, the relationship between the CAR and long-term adverse outcomes in CAD patients after percutaneous coronary intervention (PCI) is still unknown.

Methods

A total of 3561 CAD patients enrolled in the Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI: an investigation based on case records and follow-up (CORFCHD-ZZ), a retrospective cohort study conducted from January 2013 to December 2017, and 1630 patients meeting the study inclusion criteria were divided into two groups based on the CAR (CAR < 0.186; n = 1301 and CAR ≥ 0.186; n = 329). The primary outcome was long-term mortality, including all-cause mortality (ACM) and cardiac mortality. The average follow-up time was 37.59 months.

Results

We found that there were significant differences between the two groups in the incidences of ACM (P < 0.001) and cardiac mortality (P  = 0.003). Cox multivariate regression analyses demonstrated that CAR was an independent predictor of ACM [hazard ratio, 2.678; (95% confidence interval (CI), 1.568–4.576); P < 0.001] and cardiac mortality (hazard ratio, 2.055; 95% CI, 1.056–3.998; P = 0.034) in CAD patients after PCI.

Conclusion

This study revealed that the CAR is an independent and novel predictor of long-term adverse outcomes in CAD patients who have undergone PCI.
Major gastrointestinal bleeding risk with direct oral anticoagulants: Does type and dose matter? – A systematic review and network meta-analysis
Authors: Radadiya Dhruvil , Devani Kalpit , Brahmbhatt Bhaumik , Reddy Chakradhar
Published: January 2021

The relative risk of major gastrointestinal bleeding (GIB) among different direct oral anticoagulants (DOACs) is debatable. Randomized controlled trials (RCTs) comparing DOACs with each other are lacking. We performed network meta-analysis to assess whether the risk of major GIB differs based on type and dose of DOAC. Literature search of PubMed, EMBASE and Cochrane databases from inception to August 2019, limited to English publications, was conducted to identify RCTs comparing DOACs with warfarin or enoxaparin for any indication. Primary outcome of interest was major GIB risk. We used frequentist network meta-analysis through the random-effects model to compare DOACs with each other and DOACs by dose to isolate the impact on major GIB. Twenty-eight RCTs, including 139 587 patients receiving six anticoagulants, were selected. The risk of major GIB for DOACs was equal to warfarin. Comparison of DOACs with each other did not show risk differences. After accounting for dose, rivaroxaban 20 mg, dabigatran 300 mg and edoxaban 60 mg daily had 47, 40 and 22% higher rates of major GIB versus warfarin, respectively. Apixaban 5 mg twice daily had lower major GIB compared to dabigatran 300 mg (OR, 0.63; 95% CI, 0.44–0.88) and rivaroxaban 20 mg (OR, 0.60; 95% CI, 0.43–0.83) daily. Heterogeneity was low, and the model was consistent without publication bias (Egger’s test: P = 0.079). All RCTs were high-quality with low risk of bias. DOACs at standard dose, except apixaban, had a higher risk of major GIB compared to warfarin. Apixaban had a lower rate of major GIB compared to dabigatran and rivaroxaban.
Effect of disease stage and treatment outcomes on the dynamics of liver functions during and after treatment of hepatitis C with directly acting antivirals
Authors: El Kassas Mohamed , Alboraie Mohamed , El-Sayed Mohammad , Elbehiry Sherif , Sherief Ahmed , Youssef Mohamed , Moaz Inas , El Tahan Adel , Abdeen Nermeen , Eysa Basem , Aziz Ayman A. , Tawheed Ahmed , Ezzat Sameera , Hassany Mohamed
Published: January 2021

Background

Virus C infection is recently treated successfully with plenty of direct antiviral agents (DAAs). We aimed to evaluate the effect of disease stage and treatment outcome on the dynamics of liver functions during treatment of hepatitis C with DAAs.

Methods

We reported the liver function in 2354 subjects diagnosed as chronic hepatitis C before, during and after treatment with different DAAs regimens. Patients were classified into two groups according to treatment response with further subclassification according to the presence or absence of cirrhosis, and changes in liver functions were compared in each group and subgroup.

Results

Totally 2213 (94%) achieved sustained virological response (SVR) to DAAs therapy with significant improvement in all liver biochemistry. Also, there was an improvement in the non-SVR group’s liver enzymes in relapsers during and after treatment; however, there was no improvement in serum albumin. We noticed a slight increase in serum bilirubin at weeks 4 and 8 for both groups.

Conclusion

DAAs therapy is associated with improvement of the liver biochemical profile and improved outcome in the majority of chronic hepatitis C virus patients due to suppression of viral replication. However, the long-term impact of DAAs therapy needs to be further evaluated.
Fecal and mucosal microbiota profiling in pediatric inflammatory bowel diseases
Authors: Putignani Lorenza , Oliva Salvatore , Isoldi Sara , Del Chierico Federica , Carissimi Claudia , Laudadio Ilaria , Cucchiara Salvatore , Stronati Laura
Published: January 2021

Background

An altered gut microbiota profile has been widely documented in inflammatory bowel diseases (IBD). The intestinal microbial community has been more frequently investigated in the stools than at the level of the mucosa, while most of the studies have been performed in adults. We aimed to define the gut microbiota profile either by assessing fecal and colonic mucosa samples (inflamed or not) from pediatric IBD patients.

Patients and methods

Fecal and colonic samples from pediatric IBD (Crohn’s disease or ulcerative colitis) and controls were analyzed. The relative abundance of bacteria at phylum and genus/species levels and bacterial diversity were determined through 16S rRNA sequence-based of fecal and mucosal microbiota analysis.

Results

A total of 59 children with IBD (26 Crohn’s disease, 33 ulcerative colitis) and 39 controls were analyzed. A clear separation between IBD and controls in the overall composition of fecal and mucosal microbiota was found, as well as a reduced bacterial richness in the fecal microbiota of IBD. At the phylum level, abundance of Proteobacteria and Actinobacteria occurred in fecal microbiota of IBD, while species with anti-inflammatory properties (i.e., Ruminococcus) were reduced. Fusobacterium prevailed in inflamed IBD areas in comparison to noninflamed and controls samples.

Conclusion

Significant alterations in gut microbiota profile were shown in our IBD pediatric patients, in whom an abundance of species with a proinflammatory mucosal activity was clearly detected. An analysis of gut microbiota could be incorporated in designing personalized IBD treatment scenarios in future.
Structural validation and dyadic child–parent measurement invariance of the celiac disease quality of life questionnaire
Authors: Meyer Sonya , Shani Maor
Published: January 2021

Objective

The celiac disease quality of life questionnaire (CDDUX) is used widely in numerous languages worldwide. However, it's structural and construct validity and child–parent invariance had not been thoroughly examined. The objective of this study was to examine the psychometric properties of the 12-item CDDUX and the extent to which it meets the acceptable requirements of reliability and structural and convergent validity, as well as its child–parent invariance.

Methods

In this cross-sectional study, 126 dyads of children aged 8–18 years and their parents completed the Hebrew version self-report and parent-proxy report CDDUX. Recently developed methods to examine psychometric properties and to measure invariance of dyadic samples were used while properly accounting for nonindependence in measurement patterns.

Results

A three-factor structure, each with sufficient internal consistency, is confirmed for both children and parents. Removing a single indicator of the diet subscale resulted in full configural (χ2(181) = 202.277, P > 0.05, RMSEA = 0.026) and metric (χ2(189) = 209.543, P > 0.05, RMSEA = 0.043) invariance of the measure between children and parents. However, this occurred only in partial-scalar (χ2(198) = 229.813, P > 0.05, RMSEA = 0.031) and uniqueness invariance, which is nevertheless sufficient for meaningful comparison between the groups.

Conclusion

Overall, with minor modifications, the Hebrew version of the CDDUX was found to be a valid measure of children’s celiac-related quality of life when measured across children’s self-reports and parent-proxy reports. The CDDUX provides meaningful measurement and allows child–parent comparison.
Predicting survival time of Korean hepatocellular carcinoma patients using the Cox proportional hazards model: a retrospective study based on big data analysis
Authors: Kwon Yujin , Kim Jae Ri , Park Young Mok , Choi Byung Kwan , Kim Choongrak , Young Kim Hae , Yoon Myunghee
Published: January 2021

Aim

To predict survival time of Korean hepatocellular carcinoma (HCC) patients by analyzing big data using Cox proportional hazards model.

Methods

Big data of the patients who underwent treatment for HCC from 2008 to 2015, provided by Korea Central Cancer Registry, National Cancer Center, and Ministry of Health and Welfare, were analyzed. A total of 10 742 patients with HCC were divided into two groups, with Group I (3021 patients) confirmed on biopsy and Group II (5563 patients) diagnosed as HCC according to HCC diagnostic criteria as outlined in Korean Liver Cancer Association guidelines. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors of recurrence after treatment and survival status.

Results

A total of 3021 patients in Group I and 5563 patients in Group II were included in the study and the difference in survival time between the two groups was statistically significant (P < 0.05). Recurrence was only included in intrahepatic cases, and the rates were 21.2 and 19.8% while the periods from the first treatment to recurrence were 15.57 and 14.19 months, respectively. Age, diabetes, BMI, platelet, alpha-fetoprotein, histologic tumor maximum size, imaging T stage, presence of recurrence, and duration of recurrence were included in multivariate analysis.

Conclusion

By using nationwide, multicenter big data, it is possible to predict recurrence rate and survival time which can provide the basis for treatment response to develop a predictive program.
Evidence and controversies in management of thyroglossal duct cyst carcinoma
Authors: Lancini Davide , Lombardi Davide , Piazza Cesare
Published: January 2021

Purpose of review

The aim of this study was to analyse the rational of the possible therapeutic approaches to thyroglossal duct cyst carcinomas (TGDCCa), especially in consideration of their potential airway involvement, discussing the most debated issues concerning employment of thyroidectomy, neck dissection and adjuvant treatments.

Recent findings

The literature is unanimous in defining the Sistrunk procedure as the baseline of surgical treatment of TGDCCa, and in equating the vast majority of thyroid-like TGDCCas to classic thyroid cancers from a biological point of view, while the rarer squamous cell carcinomas seem to behave more aggressively. Thyroidectomy, neck dissection and radioactive iodine treatment are considered for high-risk lesions, with the addition of customized partial resection of laryngeal cartilages when airway involvement is encountered. Furthermore, the analysis of thyroid mutational markers has promise for accurate prevision of more aggressive clinical behaviours.

Even if rare, clinicians should be aware of TGDCCa due to the possibility of incidental diagnosis and, in the case of more advanced clinical scenarios, for its potential airway involvement. Sistrunk procedure combined with thyroidectomy, neck dissection and adjuvant therapy provide excellent results in high-risk patients. Additional study of pathological thyroid markers in TGDCCa is desirable to allow more individualized treatments.
The Use of Fecal Calprotectin Testing in Paediatric Disorders
Authors: Koninckx Carmen Ribes , Donat Ester , Benninga Marc A. , Broekaert Ilse J. , Gottrand Frederic , Kolho Kaija‐Leena , Lionetti Paolo , Miele Erasmo , Orel Rok , Papadopoulou Alexandra , Pienar Corina , Schäppi Michela G. , Wilschanski Michael , Thapar Nikhil
Published: January 2021

Objectives:

The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children.

Methods:

A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors.

Results:

A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9‐point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9.

Conclusions:

Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch‐Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.
Association Between Celiac Disease and Autism Spectrum Disorder: A Systematic Review
Authors: Quan Joshua , Panaccione Nicola , Jeong Jocelyn , Underwood Fox E. , Coward Stephanie , Windsor Joseph W. , Ronksley Paul E. , Gidrewicz Dominica , deBruyn Jennifer , Turner Justine M. , Lebwohl Benjamin , Kaplan Gilaad G. , King James A.
Published: January 2021

Objective:

The aim of the study was to perform a systematic review assessing the research investigating the association between celiac disease (CD) and autism spectrum disorder (ASD).

Methods:

A literature search of MEDLINE and EMBASE was performed without limits placed on year or language. Observational studies reporting on the occurrence of CD among patients with ASD and/or the occurrence of ASD among patients with CD were included. Study design, characteristics, diagnostic criteria for ASD and CD, and the frequency of positive cases in the studied sample were recorded. Study quality was assessed using an adapted Newcastle-Ottawa Quality Assessment Scale. Due to substantial heterogeneity between studies, a meta-analysis was not performed.

Results:

Of the 298 unique citations identified within our search strategy, 17 articles evaluating the association between CD and ASD were included. Of those articles, 13 observed samples of patients with ASD, and 6 observed samples of patients with CD. Overall, most studies had small sample sizes and reported no evidence for an association between the 2 conditions. However, a limited number of population-based studies of higher quality suggested a potential association between CD and ASD.

Conclusions:

Most studies assessing an association between CD and ASD are at risk for systematic and/or random error. A potential link has, however, been shown in a handful of high-quality studies, and, therefore, this comorbidity cannot be ruled out. Future studies should recruit larger sample sizes, include precise definitions of CD and ASD, and exclude patients with ASD on a gluten-free diet.
Long‐term Morbidity of Choledochal Malformations in Children
Authors: Hyvärinen Ilona , Hukkinen Maria , Kivisaari Reetta , Parviainen Helka , Mäkisalo Heikki , Koivusalo Antti , Pakarinen Mikko
Published: January 2021

Objective:

The aim of the study was to assess long‐term morbidity in children operated for choledochal malformation (CM) by relating clinical complications to liver histopathology, follow‐up imaging, liver stiffness, and biochemistry.

Methods:

A single‐center retrospective follow‐up study including all CM patients (n = 55, 71% girls) treated during 1976 to 2018 was performed. Mann‐Whitney U test and Spearman rank correlation were used for statistical analyses.

Results:

During median follow‐up of 5.8 (interquartile range, 2.5–12) years, 1 patient was lost to follow‐up whereas all survived. Intraoperative liver biopsies showed fibrosis in 32%, and patients with Metavir stage ≥2 were younger at surgery (0.36 [0.11–1.9] vs 3.8 [0.72–10.5] years, P = 0.024) than those without fibrosis. Overall, 21% had long‐term complications including cholangitis in 9 (>2 episodes in 5) patients, anastomotic stricture in 2 referred patients and adhesive volvulus or hepatocellular carcinoma in 1 each. Anastomotic strictures were successfully managed nonoperatively and hepatocellular carcinoma with thermoablation. In postoperative magnetic resonance cholangiography (MRCP) performed 6.4 (3.6–16) years after hepaticojejunostomy, diameters of both main intrahepatic ducts had decreased significantly to 3.0 (2.5–3.5) mm (P = 0.0001) but a distal cyst stump was remaining in 30% with a length of 6.0 (4.0–20) mm that associated with operation age (r = 0.71, P = 0.015) and fusiform CM type. Follow‐up ultrasound revealed mild dilation of intrahepatic bile ducts in 6.3% and mildly to moderately elevated liver biochemistry in 23%, and liver stiffness (>7 kPa) in 22%.

Conclusions:

Whilst cholangitis was the most common postoperative problem, individual patients experienced other more significant complications and one quarter of patients showed evidence of underlying liver dysfunction.
Comparison of Oral Sodium Bicarbonate and Solifenacin Treatment in Female Overactive Bladder Patients With Acidic Urine pH
Authors: Sönmez Mehmet Giray , Ecer Gökhan , Atıcı Ahmet , Özkent Mehmet Serkan , İyisoy Mehmet Sinan , Öztürk Ahmet
Published: January 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2020;26:649–653)

Overactive bladder (OAB) syndrome affects 1 of 7 US women. The syndrome is characterized by the presence of urinary urgency, with or without urgency urinary incontinence, usually accompanied by frequency and nocturia.
Increasing Obstetric Intervention for Fetal Growth Restriction Is Shifting Birthweight Centiles: A Retrospective Cohort Study
Authors: Selvaratnam R. J. , Davey M.-A. , Mol B. W. , Wallacea E. M.
Published: January 2021

(Abstracted from BJOG 2020;127:1074–1080)

One way to reduce the risk of stillbirths is to focus on improving the detection of fetal growth restriction (FGR) and providing timely delivery of the small-for-gestational-age (SGA) fetus. Detecting and delivering the SGA pregnancy at less than 40 weeks of gestation are the recommended best practice.
Effect of Pretreatment Oral Contraceptives on Fresh and Cumulative Live Birth In Vitro Fertilization Outcomes in Ovulatory Women
Authors: Lu Yao , Wang Yuan , Zhang Ting , Wang Guiquan , He Yaqiong , Lindheim Steven R. , Yu Zhangsheng , Sun Yun
Published: January 2021

(Abstracted from Fertil Steril 2020;114:779–786)

Oral contraceptives (OCs) consisting of estrogen and progesterone have extensively been used for cycle control and synchronization in the context of in vitro fertilization (IVF). Conflicting data exist among usage of OCs in women with dysmenorrhea.
PD-L1 Expression Harmonization in Gastric Cancer Using 22C3 PharmDx and SP263 Assays
Authors: Dabbagh Tamara Z. , Sughayer Maher A.
Published: January 2021

The immune checkpoint inhibitor Pembrolizumab has been FDA-approved for the treatment of gastric cancer (GC) and gastroesophageal junction (GEJ) cancer in patients who fail second-line therapy and test positive by a companion programed death ligand 1 (PD-L1) assay, the 22C3 PharmDx. It would be useful to investigate the potential interchangeability of other PD-L1 assays in order to develop a more sustainable diagnostic strategy. We investigated the possibility of harmonizing different PD-L1 assays, utilizing samples from 94 GC and GEJ patients to compare their expression using 2 laboratory developed tests (LDTs): The Dako 22C3 antibody and the Ventana SP263 run on the Ventana platform with the FDA-approved companion diagnostic test, the 22C3 PharmDx. This would be the first report assessing the 22C3 on Ventana’s platform in GC. Pearson correlation coefficients between the Dako 22C3 PharmDx and the 22C3-LDT and the Ventana SP263 assays were 0.965 (P<0.001) and 0.932 (P<0.001), respectively, which indicates an almost perfect correlation. The sensitivity and specificity were also high at different cutoffs [both 100% at combined positive score (CPS)≥1 and 92.59% and 95.52% at CPS≥10, respectively] for the comparison between Dako 22C3/22C3-LDT assays. As for the sensitivity and specificity between the Dako 22C3/Ventana SP263 assays the results were 100% and 95.67% at CPS≥1; and 96.30% and 95.52% at CPS≥10, respectively. In conclusion, the analytical performance of 22C3 and SP263 clones on the Ventana platform was close to that of the reference assay (Dako 22C3 assay), suggesting that the 2 LDTs can be utilized interchangeably with the FDA-approved standard assay as an aid to select GC and GEJ patients for Pembrolizumab treatment.
Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya
Authors: Myers Justin G. , Nwakibu Uzoma A. , Hunold Katherine M. , Wangara Ali Akida , Kiruja Jason , Mutiso Vincent , Thompson Peyton , Aluisio Adam R. , Maingi Alice , Dunlop Stephen J. , Martin Ian B.K.
Published: January 2021

Introduction

The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population.

Methods

Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups.

Results

Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves.

Conclusions

Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.
Communication Between Primary Care Pediatricians and the Pediatric Emergency Department
Authors: Beamon Bradley D. , Cortright Lindsay M. , Pawlowski Callie B. , Vasquez-Rios Virginia , Tumin Dmitry
Published: January 2021

Objectives

This study aimed to measure the quality of communication from primary care pediatricians (PCPs) to the pediatric emergency department (ED). We also sought to determine whether the quality of this communication affected patient outcomes.

Methods

We conducted a retrospective chart review of patients sent from their pediatrician to the pediatric ED during a 4-year period. The quality of communication was classified as no communication, incomplete communication, or complete communication, based on compliance with Joint Commission requirements. Outcome measures included overnight admission, total length of hospital stay, repetition of diagnostic tests, ED revisits, hospital readmissions, and initial follow-up pediatrician visit.

Results

Fifty-five patients were included in the analysis. Communication was complete in 22% of cases, incomplete in 16% of cases, and absent in 62% of cases. Medications and allergies were most often missing. The quality of communication was not associated with any of the prespecified covariates or outcome measures. Chief complaint of respiratory distress and greater severity score were associated with a greater likelihood of hospital admission from the ED.

Conclusions

Our study demonstrates a lack of documented communication between PCPs and a pediatric ED, albeit with no statistically significant impact on patient outcomes. Practices to increase the quality of PCP-ED communication could include standardizing interfacility referrals, maximizing shared electronic health record use between clinical environments, and increased collaboration between ED physicians and PCPs. Further research to investigate subjective outcomes, such as patient expectations or satisfaction associated with PCP-ED communication, may reveal other consequences of incomplete communication.
Agreement With Pediatric Suprapatellar Bursa Effusion Assessments by Point-of-Care Ultrasound After Remote Training
Authors: Riera Antonio , Leviter Julie I. , Iqbal Ammarah , Soma Gauthami , Malik Rabia N. , Chen Lei
Published: January 2021

Background

The ease of instruction for point-of-care ultrasound (POCUS) to detect suprapatellar bursa (SPB) effusions in pediatric patients is unknown. Considering in person limitations because of the coronavirus pandemic, strategies for POCUS education by remote learning are necessary.

Methods

We crafted a 90-minute didactic training that was presented via a remote learning format. The main outcome of interest was the interobserver reliability of SPB effusion assessment by novice sonologists compared with POCUS faculty. Novice sonologists were pediatric emergency medicine (PEM) fellows. Pediatric emergency medicine fellows interpreted longitudinal SPB examinations obtained in our pediatric emergency department from July 2013 to June 2020. Assessments were performed 2 months after the remote training. Pediatric emergency medicine fellows had a limited experience performing these musculoskeletal scans and were blinded to POCUS faculty and each other's assessments. Interobserver reliability was assessed with Cohen κ coefficient. Second, we calculated test characteristics of knee radiography compared with PEM POCUS faculty determination of SPB effusion by ultrasound. We further explored how effusion size measured by POCUS impacted the diagnosis by knee radiography. A receiver operator characteristic curve of knee radiography diagnosis of SPB effusion was created using the maximal height of SPB effusion by POCUS as the predictor variable.

Results

A total of 116 SPB scans in 71 patients were assessed. From this group, 70 scans were of affected knees and 46 scans were of contralateral, asymptomatic knees. The mean age of patients was 10 years and 46% were girl. The prevalence of SPB effusions was 42%. The κ coefficients between the 3 novice sonologists and POCUS faculty were 0.75 (0.62–0.87), 0.77 (0.65–0.89), and 0.83 (0.72–0.93) with 88%, 89%, and 91% agreement. Knee radiography exhibited an overall sensitivity of 65% (95% confidence interval [CI], 46–79%), specificity of 84% (95% CI, 60–97%), negative predictive value of 55% (95% CI, 43–66%), and positive predictive value of 88% (95% CI, 73–96%) to diagnose SPB effusions. The area under the receiver operator characteristic curve was 0.850. With an SPB height cutoff of 4 mm as true positives, radiography had a sensitivity of 81% and a specificity of 83%.

Conclusions

After a remote teleconference didactic session, PEM fellows were able to successfully diagnose SPB effusions using a longitudinal view with substantial interobserver reliability. Knee radiography exhibited limited sensitivity to rule out SPB effusions.
Late Complication of Congenital Diaphragmatic Hernia Repair
Authors: Sivarajah Vishalini , Bhatnagar Priyank , Tom Katherine N. , Wong Jonathan P. , Gerstle J. Ted , Moodie Rosemary G. , Wong Peter D.
Published: January 2021

Congenital diaphragmatic hernia (CDH) is associated with high early mortality. However, advances in newborn care have led to improved survival into adolescence and early adulthood. We report a 17-year-old adolescent boy with recurrent small bowel obstruction after CDH repair at 2 days of age. Emergency physicians should be aware of late complications after neonatal CDH repair.
Targeted Treatment of Triple-Negative Breast Cancer
Authors: Young Joanna A. , Tan Antoinette R.
Published: January 2021

Triple-negative breast cancer is increasingly recognized as a heterogeneous entity that can be categorized according to histologic, molecular, and clinical subtypes. While chemotherapy remains the backbone of treatment for this disease, there are now several available targeted agents including immunotherapy, poly(adenosine diphosphate-ribose) polymerase inhibitors, and most recently a Food and Drug Administration–approved antibody-drug conjugate sacituzumab govitecan-hziy as a third-line treatment of metastatic triple-negative breast cancer. We review several actionable targets for triple-negative breast cancer and describe promising nonimmunotherapeutic agents including cyclin-dependent kinase inhibitors, androgen receptor inhibitors, mitogen-activated protein kinase inhibitors, phosphoinositide 3-kinase inhibitors, AKT (also known as protein kinase B) inhibitors, and antibody-drug conjugates.
Using phylogenetic surveillance and epidemiological data to understand the HIV-1 transmission dynamics in French Guiana
Authors: Arantes Ighor , Bello Gonzalo , Darcissac Edith , Lacoste Vincent , Nacher Mathieu
Published: January 2021

Objective:

The aim of this study was to understand the transmission dynamics of the HIV-1 subtype B epidemic in French Guiana and the factors that shaped the expansion of major phylogenetic transmission clusters.

Design:

HIV-1 subtype B pol sequences with associated epidemiological data obtained from 703 treatment-naive patients living in French Guiana between 2006 and 2012, which correspond to 91% of all HIV cases diagnosed in that period, were employed in this study.

Methods:

Maximum likelihood and Bayesian methods were used to construct phylogenetic trees, identify transmission clusters and estimate intervals between successive infections. Statistical analysis was performed to evaluate epidemiological characteristics associated with cluster membership.

Results:

HIV-1 subtype B pol sequences from French Guiana were distributed in 10 large/medium transmission clades (LMTC, n > 10, 55%), 19 small transmission clades (STC, n = 3–8, 10%), 36 dyads (10%) or were nonclustered (25%). The rate of clustering did not differ by sex or clinical stage, but sex workers, crack-cocaine users, young individuals (15–20 years) and nationals or migrants from neighbouring South American countries were more likely to cluster within LMTC than individuals from other groups. We estimated that 53–63% of immigrants were infected after the arrival in French Guiana and that 50% of HIV transmissions within LMTC occurred during the first 2 years after infection.

Conclusion:

These findings reinforce the notion that high-risk sexual behaviours among young individuals and migrants (postmigration) combined with late HIV diagnosis are key drivers of onward dissemination of major HIV transmission clusters in French Guiana.
Brief Report: Financial Incentives and Real-Time Adherence Monitoring to Promote Daily Adherence to HIV Treatment and Viral Suppression Among People Living With HIV: A Pilot Study
Authors: Bien-Gund Cedric H. , Ho Joshua I. , Bair Elizabeth F. , Marcus Noora , Choi Rebekah Ji , Szep Zsofia , Althoff Amy , Momplaisir Florence M. , Thirumurthy Harsha
Published: January 2021

Background:

Interventions to promote medication adherence and viral suppression are needed among HIV-positive individuals. We aimed to determine the feasibility, acceptability, and preliminary impact of daily financial incentives linked to real-time adherence monitoring among treatment-experienced individuals.

Methods:

At an HIV clinic in Philadelphia, we conducted a pilot randomized trial among treatment-experienced HIV-positive adults with unsuppressed viral loads (>400 copies/mL). Participants randomized to the intervention group were eligible for daily lottery-based financial rewards dependent on antiretroviral therapy (ART) adherence, measured by a wireless-enabled electronic pill bottle. Participants also received a financial incentive for achieving viral suppression at 3 months. The control group received the standard of care. We measured acceptance and feasibility through follow-up survey at 3 months, viral suppression at 3 months, and adherence.

Results:

Among 29 participants, 28 (93%) completed 3-month follow-up, and 24 (83%) completed a 3-month laboratory visit. Electronic pill bottles were highly acceptable to participants, with most strongly agreeing that they worked well, were reliable, and easy to use. Among those who received the intervention, 77% were very satisfied with their experience. Among those who completed the 3-month laboratory visit, viral suppression was achieved by 40% in the intervention group and 29% in the control group. ART adherence ≥80% was achieved by 36% and 25% in the intervention and control groups, respectively.

Conclusions:

Daily financial incentives coupled with real-time adherence monitoring are a promising strategy to support ART adherence among HIV-positive individuals who are not virally suppressed. This novel approach warrants testing in a larger trial.
Performance of Methods to Estimate Low-Density Lipoprotein Cholesterol in Women With and Without HIV Infection
Authors: Rana Mariam N. , Kim Chang H. , Sullivan Claire E. , Longenecker Chris T. , Al-Kindi Sadeer G.
Published: January 2021

Background:

Low-density lipoprotein cholesterol (LDL-C) is estimated from total cholesterol, high-density lipoprotein cholesterol and triglycerides using predefined equations which assume fixed or varying relationships between these parameters and may underestimate or overestimate LDL-C. Data on the performance of these equations in persons with HIV are limited. We sought to investigate the utility of the 3 most widely used methods (Friedewald, Hopkins, and the recently proposed NIH equation) to predict LDL-C in persons with HIV.

Methods:

We identified 7397 direct LDL-C (5219 HIV, 2127 uninfected controls, 51 seroconvertors) measurements in the Women's Interagency HIV Study, and used the 3 equations (Friedewald, Hopkins, and NIH) to calculate LDL-C. We compared the performance of the 3 equations using root mean square error and coefficient of determination (R2).

Results:

Overall, the Friedewald equation had the best performance characteristics, outperforming Hopkins and NIH methods with lower root mean square error and higher R2 at lower triglyceride levels. However, this association did not hold true at higher triglyceride levels (quartiles 3 and 4), whereas the Hopkins equation had better performance characteristics in quartile 3, none of the 3 equations were optimal in quartile 4. After adjusting for fasting status and triglycerides levels, HIV+ had larger mean difference compared with directly measured LDL using all 3 methods.

Conclusions:

All 3 methods have lower accuracy in HIV+ vs HIV− women, even after adjusting for triglyceride levels and fasting status. Further research should focus on identifying methods to estimate LDL-C in HIV.
Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia
Authors: Cutuli Salvatore Lucio , Grieco Domenico Luca , Menga Luca Salvatore , De Pascale Gennaro , Antonelli Massimo
Published: January 2021

Purpose of review

We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia.

Recent findings

Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation.

Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research.
Same-day Discharge Is Safe and Effective After Implant-Based Breast Reconstruction
Authors: Hammond Jacob B. , Thomas Olivia , Jogerst Kristen , Kosiorek Heidi E. , Rebecca Alanna M. , Cronin Patricia A. , Casey William J. , Kruger Erwin A. , Pockaj Barbara A. , Teven Chad M.
Published: January 2021

Background

Same-day discharge after mastectomy is a recently described treatment approach. Limited data exist investigating whether same-day discharge can be successfully implemented in patients undergoing mastectomy with immediate implant-based breast reconstruction (IBR).

Methods

Patients having mastectomy with IBR from 2013 to 2019 were reviewed. Enhanced recovery with same-day discharge was implemented in 2017. Patient characteristics, oncologic treatments, surgical techniques, and 90-day postoperative complications and reoperations were analyzed comparing enhanced recovery patients with historical controls.

Results

A total of 363 patients underwent nipple-sparing (214, 59%) or skin-sparing (149, 41%) mastectomy with 1-stage (270, 74%) or tissue expander (93, 26%) IBR. Enhanced recovery was used for 151 patients, with 79 of these patients (52%) discharged same-day. Overall, enhanced recovery patients experienced a significantly lower rate of 90-day complications (21% vs 41%, P < 0.001), including hematoma (3% vs 11%, P = 0.002), mastectomy flap necrosis (7% vs 15%, P = 0.02), seroma (1% vs 9%, P < 0.001), and wound breakdown (3% vs 9%, P = 0.05). Postoperative complication rates did not significantly differ among enhanced recovery patients discharged same day. Postoperative admissions significantly decreased after enhanced recovery implementation (100% to 48%, P < 0.001), and admitted enhanced recovery patients experienced a lower length of stay (1.2 vs 1.8, P < 0.001). Enhanced recovery patients experienced a lower incidence of ≥1 unplanned reoperation (22% vs 33%, P = 0.01); overall average unplanned and total reoperations did not significantly differ between groups.

Conclusions

In conjunction with enhanced recovery practices, same-day discharge after mastectomy with IBR is a safe and feasible treatment approach.