bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous epidural anesthesia with double catheters for cesarean section in a patient with severe pulmonary hypertension
Authors: Wang Pingzhu , Chen Xiaojing , Zhang Jingwen , Ma Yushan
Published: December 2021

Rationale:

Pregnancy in a woman with pulmonary hypertension (PH) carries prohibitively high risks of cardiopulmonary complications and high maternal and fetal morbidity and mortality. Anaesthetic management during delivery or cesarean section is very important for the prognosis of pregnant women with PH. The choice between general anesthesia or intraspinal anesthesia is controversial. There have been few case reports of anesthetic management under continuous epidural anesthesia with double catheters in such patients.

Patient concerns:

A 35-year-old pregnant woman presented to the emergency department with fatigue and shortness of breath for 10 days at 16 weeks of gestation.

Diagnosis:

According to transthoracic echocardiogram, her pulmonary artery pressure (PAP) was 75 mm Hg, and she had a dilated left ventricle (67 mm) and a ventricular septal defect (1.7 mm) with a bidirectional shunt.

Interventions:

Elective cesarean section under continuous epidural anesthesia with double catheters to terminate a pregnancy in order to avoid development of cardiac failure.

Outcomes:

The pregnant woman underwent cesarean section safely and steadily under continuous epidural anesthesia with double catheters. She was discharged on the seventh postoperative day.

Lessons:

The advantages of continuous epidural anesthesia with double catheters are stable hemodynamics and complete analgesia. The continuous epidural anesthesia with double catheters can be applied to patients with cardiopulmonary disease like severe PH. Compared with general anesthesia, spinal anesthesia, and single-catheter epidural anesthesia continuous epidural anesthesia is a better option for patients with both PH and heart failure.
Exercise-based pulmonary rehabilitation for a post-COVID-19 pulmonary fibrosis patient
Authors: Choi Kyungyeul , Kim Minwoo , Lee Son mi , Kim JongKyu
Published: December 2021

Rationale:

Pulmonary fibrosis is an infamous sequela of coronavirus disease 2019 (COVID-19) pneumonia leading to long-lasting respiratory problems and activity limitations. Pulmonary rehabilitation is beneficial to improve the symptoms of lung fibrosis. We experienced a post-COVID-19 pulmonary fibrosis patient who received a structured exercise-based pulmonary rehabilitation program.

Patient concerns:

This article presents a case of successful pulmonary rehabilitation of a patient with post-COVID-19 pulmonary fibrosis. The patient could not cut off the oxygen supplement even after a successful recovery from COVID-19.

Diagnosis:

Diagnosis of COVID-19 was based on the reverse transcription-polymerase chain reaction (RT-PCR). Pulmonary fibrosis was diagnosed by patient's complaint, clinical appearance, and computed tomography (CT) on chest.

Intervention:

The patient underwent ten sessions of exercise-based rehabilitation program according to Consensus Document on Pulmonary Rehabilitation in Korea, 2015.

Outcome:

On the 8th day, he could cut off the oxygen supplementation and complete the one-hour exercise without oxygen. He was discharged after completing the 10-session program without any activity limitations.

Lessons:

Exercise-based pulmonary rehabilitation will help the post-COVID-19 pulmonary fibrosis patients. This case suggested the importance of pulmonary rehabilitation program to the post-COVID-19 pulmonary fibrosis patient.
Spinal fusion with motor evoked potential monitoring using remimazolam in Alström syndrome
Authors: Arashiro Ayako , Shinzato Hayato , Kamizato Kota , Kakinohana Manabu
Published: December 2021

Rationale:

Alström syndrome is a rare genetic disorder characterized by obesity, diabetes mellitus, cardiomyopathy, and liver dysfunction. Further, scoliosis, a common symptom of Alström syndrome, often requires surgical intervention for functional impairments. Motor evoked potential (MEP) monitoring and other electrophysiological tests are essential when performing surgery for functional scoliosis. However, there are few reports on how to maintain general anesthesia in Alström syndrome. Here, we describe a patient with Alström syndrome who underwent surgery for scoliosis under general anesthesia with remimazolam and MEP monitoring.

Patient concerns:

A 17-year-old woman (height, 140 cm, weight, 64.5 kg) diagnosed with Alström syndrome was scheduled for a posterior spinal fusion for functional scoliosis. Other associated comorbidities of Alström syndrome present were dilated cardiomyopathy, type 2 diabetes mellitus, obesity (body mass index, 32.1 kg/m2), amblyopia (light perception), and hearing impairment (speech awareness threshold 50 dBHL in each ear).

Diagnoses, interventions, and outcomes:

Posterior spinal fusion was planned for functional scoliosis. While investigating the dilated cardiomyopathy, transthoracic echocardiography showed global wall hypokinesis, with 45% left ventricular ejection fraction. The left ventricle was dilated, with left ventricular end-diastolic and end-systolic diameters of 55 and 42 mm, respectively. This finding along with the hypertriglyceridemia associated with Alström syndrome led us to conclude that propofol should be avoided. Thus, we induced general anesthesia using remimazolam. MEP monitoring was performed, and the patient experienced no motor impairments during the surgery.

Lessons:

Myocardial and hepatic dysfunction determine the prognosis of patients with Alström syndrome. Thus, anesthesia that preserves liver function should be selected in such cases. In patients with hypertriglyceridemia, propofol should be avoided, and using remimazolam, an ultrashort-acting benzodiazepine, may be appropriate. In this case, reviewing the Patient State Index with SedLine allowed us to perform MEP monitoring uneventfully, and the posterior spinal fusion was completed without any motor impairment.
Lymphoplasmacyte-rich meningioma in the central nervous system
Authors: Wang Han , He Bin , Wang Yuelong , Chen Haifeng , Huang Siqing , Xu Jianguo
Published: December 2021

Rationale:

Lymphoplasmacyte-rich meningioma (LPRM) is a rare meningioma characterized by significant infiltration of plasma cells and lymphocytes, and changes in the ratio of meningeal epithelial components. According to the World Health Organization, tumors of the central nervous system are classified as grade I tumors.

Patient concerns:

A 44-year-old man presented to our department with complaints of limb weakness accompanied by hand numbness. Half a month before admission, the patient's limb weakness worsened and he could not walk and raise his hands, with limb sensory disturbance and incontinence.

Diagnosis:

Magnetic resonance imaging of the head and cervical spinal cord showed a diffuse extramedullary mass creeping on the tentorium and skull base meninges along the clivus down to the sixth cervical spinal meninges. The cervical spinal cord was enveloped and pressed (Fig. 1A-C). Postoperative histopathological examination showed meningothelial areas admixed with lymphocytes and plasma cells (Fig. 2D-H), indicating that the mass was a LPRM.

Intervention:

Suboccipital craniotomy, C1 laminectomy, and C2-C6 laminoplasty were performed for this patient, and postsurgical pathology showed that the tumor was a LPRM with large amounts of lymphocytes and plasma cells.

Outcome:

After 2 weeks of active treatment, the patient died of worsening pneumonia.

Lessons:

LPRM is a rare variant of meningioma, and it is more unusual that the lesions involve the intracranial dura mater and the entire cervical spinal meninges. So far, surgical resection has been the main treatment for LPRM, but according to its own characteristics of lymphoplasmacyte-rich, immunotherapy may become a new treatment option.
The differences between fecal microbiota and intestinal fluid microbiota in colon polyps
Authors: Zhou Xi , Zhang Shuoqiu , Liu Dan , Qian Haihua , Zhang Dan , Liu Qiuhui
Published: December 2021

Generally, intestinal microbiota can be classified into intestinal cavity microbiota and mucosal microbiota, among which, the former is the default type. This study aimed to identify the differences between fecal microbiota and intestinal fluid microbiota in colon polys.

This study enrolled patients with colon polys who met the Rome-III criteria to carry out 16s rDNA gene sequencing. Then, both fresh feces as well as intestinal fluid was sampled. Thereafter, α/β diversities, together with the heterogeneities with regard to microbial function and structure were assessed among those intestinal fluid and fresh feces samples collected.

According to bioinformatics analysis, difference in α-diversity was not statistically significant between intestinal fluid microbiota and fecal microbiota among patients with colorectal polyps (CPs). Non-metric multidimensional scaling analysis of β-diversity revealed that differences were of statistical significance between both groups. In addition, linear discriminant analysis effect size analysis displayed great heterogeneities in intestinal microbiota of both groups, including Firmicutes, Clostridia, and Phascolarctobacterium. At the phylum level, difference (P = .016) in Spirochaetes was statistically significant between the intestinal fluid group and fecal group. At the family level, differences in Bacteroidaceae, Micrococcaceae, F16, Spirocheatacae, Enterobacteriaceae, Cardiobacteriaceae, Turkish Spirobacteriaceae, Bifidobacteriaceae, and Dethiosulfovibrionaceae were statistically significant between the 2 groups. At the genus level, there were statistical differences between the 2 groups in terms of Bacteroidetes, Rothia, Actinobacillus, F16, Treponema, Oscillospira, Turicibacter, Sharpea, Heamophilus, Veillonella, and Cardiobacterium.

There are statistical differences in the composition between intestinal microbiota and fecal microbiota in CP patients, both of which are equally important and indispensable for analyzing the intestinal microbiota in CP patients.
Efficacy and safety of traditional Chinese herbal medicine combined with HAART in the treatment of HIV/AIDS
Authors: Qian Zhenzhen , Zhang Yujin , Xie Xiaoli , Wang Junwen
Published: December 2021

Background:

Acquired immunodeficiency syndrome (AIDS) is one of the infectious diseases pandemic in the word. Traditional Chinese herbal medicine, as an alternative and complementary therapy of highly active antiretroviral therapy (HAART), has been put into the treatment of human immunodeficiency virus (HIV)/AIDS over 30 years due to its good therapeutic effects and high safety, while there is a lack of evidence-based medicine support. The purpose of this study is to explore the efficacy and safety of traditional Chinese herbal medicine combined with HAART for HIV/AIDS patients.

Methods:

We will search all randomized controlled trials of Chinese herbal medicine combined with HAART in the treatment of HIV/AIDS from electronic databases including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database and Chinese Biomedical Literature Database from inception to December 31, 2021. Literature screening will be conducted through EndNote software, and data extraction will be processed according to inclusion and exclusion criteria by two independent researchers. We will use Review Manager 5.4 and Stata 16 software for data analysis and publication bias test.

Results:

This systematic review and meta-analysis will provide a high-quality evidence for the efficacy and safety of traditional Chinese herbal medicine combined with HAART in the treatment of HIV/AIDS.

Conclusion:

The conclusion of this review will provide an objective assessment to evaluate whether Chinese herbal medicine integrated with HAART has the effect of improving the efficiency and depressing the toxicity.

Registration number:

INPLASY2021110082.
Development and validation of the Chinese surgical inpatient satisfaction and comfort questionnaire
Authors: Liu Bolin , Liu Shujuan , Zheng Tao , Wang Yuan , Cao Baohua , Wang Zhiling , Yu Lijun , Zhang Na , Zhao Binfang , Lu Dan , Chen Lei , Ma Tao , Zhong Yuexia , He Shiming
Published: December 2021

Patient feedback can provide insights to assess and improve the quality of healthcare. This study aimed to develop a measure of surgical inpatient satisfaction and comfort and examine its acceptability, validity, and reliability among discharged surgical patients.

This multicenter, descriptive, cross-sectional study was conducted at three tertiary hospitals in Shaanxi Province, China. A random sample of patients admitted to the surgical inpatient departments of the three hospitals between November and December 2018 was recruited. An analysis was conducted on the acceptability, validity, and reliability of a newly developed measure of satisfaction with surgical inpatient services.

A total of 1582 out of 1805 (87.6%) eligible patients completed the questionnaire (average time taken = 17.1 ± 10.3 minutes), which indicated high acceptability. Sociodemographic differences between the participants and non-participants were not significant. Using factor analysis, the following 7 dimensions (number of items: 65, variance explained: 68.0%) were identified: medical care (19 items), nursing care (15 items), environment and logistics (11 items), postoperative and hospitalization experiences (11 items), feeling nervous and afraid (4 items), operating room services (3 items), and visiting (2 items). The latent structure of the assessment was examined and validated using exploratory and confirmatory factor analyses, respectively. All item loadings were >0.4. All dimensions demonstrated satisfactory internal consistency (Cronbach's alphas = 0.83–0.96) and test-retest reliability (intra-class correlation coefficients = 0.77–0.96).

The Chinese Surgical Inpatient Satisfaction and Comfort Questionnaire has strong psychometric properties and can be used to assess patient satisfaction with public hospital surgical inpatient services in China. A distinguishing feature of this questionnaire is the inclusion of a subscale that assesses comfort as a dimension of patient satisfaction. Such instruments can be used to identify the factors that should be addressed to improve the quality of patient care. Further research is needed to determine the role of assessment in quality improvement.
Spinal cord stimulation in the approach to chronic pelvic pain
Authors: Romero-Serrano Estefanía , Esparza-Miñana José Miguel
Published: December 2021

Rationale:

Chronic pelvic pain (CPP) is a pain related to pelvic structures that arise from posttraumatic pain, postsurgical pain, or somatic or visceral pain syndromes. Despite the available treatment options, CPP remains mostly untreated, due to difficulties in covering such a large area.

Patient concerns:

A 46-year-old woman presented chronic low back pain and CPP for more than 1 year and 6 months respectively after multiple pelvic fractures.

Diagnosis:

Pelvic fractures and a severe lumbar facet arthrosis were revealed through computed tomography and lumbosacral nuclear magnetic resonance imaging. Evidence of a reduced amplitude in the left femoral nerve and a demyelinating neuropathy in the left pudendal nerve were also detected.

Intervention:

A pharmacologic treatment was prescribed, consisting of celecoxib, fluoxetine, gabapentin, and morphine. Since no pain relief was achieved, spinal cord stimulation was performed using spectra WaveWriter system, placing 2 octopolar linear leads over the bilateral T8 and T9 vertebras with the help of a 3-dimensional neural targeting program.

Outcomes:

Two weeks after the intervention a reduction of 80% of the pain was achieved, which led to the removal of the pharmacologic treatment. Additionally, both EuroQOL-5D and visual analogue scale scores improved after the intervention.

Lesson:

Through the combination of spinal cord stimulation Spectra Wavewriter and 3D programming technology, both lumbar and leg pain and CPP were successfully relieved, along with an improvement in the quality of life of the patient.
Colonic diverticular perforation by a migrated biliary stent
Authors: Park Tae Young , Hong Sung Woo , Oh Hyoung-Chul , Do Jae Hyuk
Published: December 2021

Rationale:

Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature.

Patients concerns:

A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago.

Diagnoses:

Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis.

Interventions:

Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed.

Outcomes:

On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications.

Lessons:

Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.
Efficacy and safety of acupuncture combined with Chinese herbal medicine in the treatment of angina pectoris of coronary heart disease (CHD)
Authors: Wang Shuang , Liu Ai Dong , Wang Zhilei , Zhang Yue
Published: December 2021

Background:

Coronary heart disease (CHD) angina pectoris is a clinical syndrome in which episodic chest pain or chest discomfort is the main manifestation of temporary ischemia and hypoxia of the myocardium due to coronary atherosclerosis and coronary artery functional changes (spasm). A large amount of clinical evidence confirms that acupuncture combined with Chinese herbal medicine in the treatment of CHD and angina pectoris can relieve the symptoms of angina pectoris and improve the performance of electrocardiograph ischemia; It still has obvious therapeutic effects in regulating the levels of cardiovascular regulatory peptides ET and cGRP. To better evaluate the effectiveness and safety of acupuncture combined with Chinese herbal medicine in the treatment of CHD and angina pectoris, we designed a systematic evaluation program to provide a reliable scientific basis for the future use of this method.

Methods:

Search Pubmed database, Embase, Cochrane library, Chinese Biomedical Literature CD-ROM Database (CBMdisk), China Journal Network Full-text Database (CNKI), Wanfang Database, Web of Science (SCI-E), the retrieval time is established from each database Until October 2021, search for relevant eligible randomized controlled trials with keywords or subject terms “acupuncture”, “Chinese herbal medicine”, and “CHD angina”. Outcome indicators were clinical symptoms of CHD and angina pectoris, changes in electrocardiogram, changes in blood lipids, and significant improvement in traditional Chinese medicine syndromes before and after treatment. Two researchers independently carried out data extraction and quality assessment, and use RevMan5.3 software to carry out final data analysis and assessment.

Results:

This study provides a reliable clinical scientific basis for acupuncture combined with Chinese herbal medicine for the treatment of CHD and angina pectoris.

Conclusion:

Acupuncture combined with Chinese herbal medicine can effectively relieve the clinical symptoms of CHD and angina pectoris and improve the performance of electrocardiograph. At the same time, it can reduce the cardiovascular regulatory peptide ET and increase the level of cGRP in the patient's plasma, thus confirming its effectiveness and safety.
Cooled-radiofrequency neurotomy for the treatment of chronic lumbar facet (zygapophyseal) joint pain
Authors: Candan Burcu , Gungor Semih
Published: December 2021

Cooled-radiofrequency (CRFA) is a newer technique and may have some theoretical advantages over traditional radiofrequency ablation (TRFA). In this study, we aimed to investigate the efficacy and safety of CRFA for the treatment of lumbar facet joint-mediated pain. In this retrospective study, we evaluated 185 CRFA performed on 105 patients. All patients with axial lower back who received the preliminary diagnosis of lumbar facet joint-mediated pain and refractory to conservative therapy underwent diagnostic medial branch blocks. CRFA was recommended to those patients who responded favorably to two sets of diagnostic medial branch blocks. Pain scores in numeric rating scale (NRS) were recorded pre-treatment and post-treatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.

Primary outcome measure determined as the improvement in NRS, for at least 50% or more, was achieved in both 1st (4–8 weeks) and 2nd (>2–6 months) follow-up (FU) with 60.5% and 53.6% reduction in NRS respectively. Our subgroup analysis comparing the younger (<50) and older (≥50) age groups showed superior pain relief with CRFA in the older (≥50) age group, both in the 1st (4–8 weeks) and 2nd (>2–6 months) FU time points (63.4% and 58.4% reduction in NRS, respectively). Cooled-radiofrequency ablation is an effective and safe procedure for the treatment of chronic lumbar facet joint related pain. The duration of pain relief was comparable to traditional radiofrequency ablation as reported in the literature.
Multimodal ultrasound imaging of persistent urogenital sinus with uterus didelphys and double vagina malformation
Authors: Wang Yue , Hu Shourong , Wang Huifang
Published: December 2021

Rationale:

Persistent urogenital sinus (PUG) with uterus didelphys and double vagina is a rare urogenital anomaly. The diagnosis is based on magnetic resonance examination and cystoscopy. To the best of our knowledge, there is no literature report of PUG diagnosed by ultrasound alone.

Patient concern:

A 23-year-old woman presented with atypical menstruation and recurrent hematuria for 13 years and recurrent lower abdominal pain for 12 years.

Diagnosis:

PUG was diagnosed through multiple ultrasound modalities, including transabdominal 2-dimensional ultrasound, transrectal bi-plane high-frequency ultrasound, and contrast-enhanced ultrasound. We diagnosed this malformation preoperatively by accurately measuring the length of urethra and common channel through multimodal ultrasound imaging.

Interventions:

Urethra separation and reconstruction, vaginal pull-through and artificial vaginoplasty, and bilateral hysterosalpingectomy were performed.

Outcomes:

The postoperative course was uneventful. She was urinating normally after half a year and used continuous vaginal dilatation to avoid stenosis.

Lessons:

PUG associated with uterus didelphys and double vagina is an extremely rare malformation of the reproductive system. Multimodal ultrasound imaging can be used to diagnose this malformation preoperatively clearly and to accurately measure the length of urethra and common channel, providing an imaging basis for preparing an operative plan.
Comparison of high and low-dose epinephrine & endoclip application in peptic ulcer bleeding
Authors: Akay Tamer , Leblebici Metin
Published: December 2021

Peptic ulcer disease accounts for 50% to 70% of acute upper gastrointestinal bleeding cases. There is no consensus on the treatment of peptic ulcer bleeding (PUB) using endoscopic techniques. This study aimed to compare endoscopic techniques for PUB.

Patients with PUB who were hospitalized between January 2014 and June 2020 were included in this study. They were divided into 3 groups: endoclip and low-dose epinephrine injection (0–2 mg, Group 1, n = 62), endoclip and high-dose epinephrine injection (2–4 mg, Group 2, n = 54), and endoclip only (Group 3, n = 64).

Early bleeding and permanent hemostasis were higher in Group 2 (P = .014, .035). When evaluated in terms of late hemostasis and urgent surgical need, there was no significant difference between the groups (P > .05). Group 2 received a higher amount of blood. Thirty-day mortality occurred in 16.5%, 22.2%, and 9.4% of patients in Groups 1, 2, and 3, respectively. Group 2 had a longer hospital stay than Groups 1 and 3 (P = .008). The endoscopic success rates were 80.6%, 72.2%, and 90.6% in Groups 1, 2, and 3, respectively.

In PUB, if the patient's Rockall score is high and the ulcer size is larger than 2 cm, endoclip application can be used as the main treatment. Addition of epinephrine may be considered when necessary.
From Concept to Publication
Authors: Calhoun Aaron W. , Gross Isabel T. , Mallory Leah B. , Shepard Lindsay N. , Adler Mark D. , Maa Tensing , Auerbach Marc A. , Cheng Adam , Kessler David O. , Whitfill Travis M. , Duff Jonathan P.
Published: December 2021

Background

As simulation matures, it is critical to develop pathways for researchers. A recent analysis, however, demonstrates a low conversion rate between abstract and peer-reviewed journal publication in our field. The International Network for Simulation-based Pediatric Innovation, Research, and Education has used the ALERT Presentation process for the past decade as a means of accelerating research. In this study, we analyze the scholarly products attributable to ALERT Presentations.

Methods

Surveys were distributed to all International Network for Simulation-based Pediatric Innovation, Research, and Education Advanced Look Exploratory Research Template (ALERT) Presentation first authors from January 2011 through January 2020. Presenters were asked to provide information on abstracts, grants, journal publications, and book chapters related to their ALERT Presentation, as well as basic demographic information. A structured literature search was conducted for those ALERT Presentations whose authors did not return a survey. The resulting database was descriptively analyzed, and statistical correlations between demographic variables and scholarship were examined.

Results

One hundred sixty-five new ALERT presentations were presented over 10 years. We identified 361 associated scholarly works (170 conference abstracts, 125 peer-reviewed journal publications, 65 grants, and 1 book chapter). Sixty-one percent (101 of 165) of ALERT Presentations produced at least 1 item of scholarship, and 59% (34 of 58) of ALERT Presentations that resulted in at least 1 abstract also led to at least 1 peer-reviewed journal article. Presenter gender was associated with likelihood of journal publication.

Conclusions

The ALERT Presentation process is an effective approach for facilitating the development of projects that result in disseminated scholarship. Wider adoption may benefit other simulation and education research networks.
ESBL plasmids in Klebsiella pneumoniae: diversity, transmission, and contribution to infection burden in the hospital setting
Authors: Hawkey Jane , Wyres Kelly L , Judd Louise M , Harshegyi Taylor , Blakeway Luke , Wick Ryan R , Jenney Adam W J , Holt Kathryn E
Published: December 2021

Background

Resistance to third-generation cephalosporins, often mediated by extended-spectrum beta-lactamases (ESBLs), is a considerable issue in hospital-associated infections as few drugs remain for treatment. ESBL genes are often located on large plasmids that transfer horizontally between strains and species of Enterobacteriaceae and frequently confer resistance to additional drug classes. While plasmid transmission is recognised to occur in the hospital setting, the frequency and impact of plasmid transmission on infection burden, compared to ESBL+ strain transmission, is not well understood.

Methods

We sequenced the genomes of clinical and carriage isolates of Klebsiella pneumoniae species complex from a year-long hospital surveillance study to investigate ESBL burden and plasmid transmission in an Australian hospital. Long-term persistence of a key transmitted ESBL+ plasmid was investigated via sequencing of ceftriaxone-resistant isolates during four years of follow-up, beginning three years after the initial study.

Results

We found 25 distinct ESBL plasmids. One (Plasmid A, carrying blaCTX-M-15 in an IncF backbone similar to pKPN-307) was transmitted at least four times into different Klebsiella species/lineages and was responsible for half of all ESBL episodes during the initial one-year study period. Three of the Plasmid A-positive strains persisted locally 3–6 years later, and Plasmid A was detected in two additional strain backgrounds. Overall Plasmid A accounted for 21% of ESBL+ infections in the follow-up period.

Conclusions

Whilst ESBL plasmid transmission events were rare in this setting, they had a significant and sustained impact on the burden of ceftriaxone-resistant and multidrug-resistant infections.

summary

We detected a blaCTX-M-15 plasmid (Plasmid A) that transferred four times into different Klebsiella lineages, causing 50% of ESBL episodes during the initial study. Three Plasmid A-positive strains persisted locally 3–6 years later, accounting for 21% of ESBL+ infections.
Assessing Immunity by Quantitative Measurement of SARS-CoV-2 IgG Antibodies in Fingerstick Samples
Authors: Garza Javier T. , Quick Jacob , Chatterjee Dev , Garr Robert P. , Varadhachary Atul , Linbeck Leo
Published: December 2021

COVID-19 has affected billions of people around the world directly or indirectly. The response to the pandemic has focused on preventing the spread of the disease and improving treatment options. Diagnostic technologies have played a key role in this response since the beginning of the pandemic. As vaccines and other treatments have been developed and deployed, interest in understanding and measuring the individual level of immune protection has increased. Historically, use of antibody titers to measure systemic immunity has been constrained by an incomplete understanding of the relationship between antibodies and immunity, the lack of international standards for antibody concentration to enable cross-study comparisons, and insufficient clinical data to allow for the development of robust antibody-immunity models.

However, these constraints have recently shifted. With a deeper understanding of antibodies, the promulgation of WHO antibody standards, and the development of immunity models using datasets from multiple COVID-19 vaccine trials, certain types of quantitative antibody tests may now provide a way to monitor individual or community immunity against COVID-19. Specifically, tests that quantitate the concentration of anti-RBD IgG –antibodies that target the receptor binding domain of the S1 spike protein component of the SARS-CoV-2 virus – show promise as a useful and scalable measure of the COVID-19 immunity of both individuals and communities. However, to fulfill this promise, a rapid and easy-to-administer test is needed.

To address this important clinical need, Brevitest deployed its point-of-care-capable technology platform that can run a rapid (<15 minute), quantitative antibody test with a sample of 10 μl of whole blood from a fingerstick. The test we validated on this platform measures the concentration of anti-RBD IgG in Binding Antibody Units per milliliter (BAU/mL) per WHO Reference Standard NIBSC 20/136.

In this paper, we present studies used to characterize the Brevitest anti-RBD IgG assay and evaluate its clinical performance, lower limits of measurement, precision, linearity, interference, and cross-reactivity. The results demonstrate the ability of this assay to measure a patient’s anti-RBD IgG concentration. This information, together with models developed from recent COVID-19 vaccine clinical trials, can provide a means of assessing the current level of immune protection of an individual or community against COVID-19 infection.
The health effects of Chunga Dumpsite on surrounding communities in Lusaka, Zambia
Authors: Chibwe Wilson , Mbewe Aaron , Hazemba Alice Ngoma
Published: December 2021

Background

Dumpsites in low and middle income countries (LMICs) are commonly used for solid waste disposal as opposed to landfills. However, these are naturally unsanitary hence provide ideal conditions for breeding of disease transmitting agents and become predisposing factors for spread of diseases and infections to surrounding communities. This study aimed at determining the Health Effects of Chunga Dumpsite on surrounding communities in Lusaka, Zambia.

Design and Methods

This was a mixed method design and employed a cross sectional approach and case study conducted concurrently. Communities were stratified by distance into Stratum One (within 250 meters radius) and Two (above 250 to 500 meters). Quantitative data were collected from total 200 households thus 100 households from each stratum by using self-administered questionnaires. Qualitative data were collected from Two Key informants from the Local Authority and 15 participants using semi-structured interview guide. Both data were collected from December 22nd, 2018 to February 18th, 2019.

Results

Results revealed that smoke and various gasses emitted from burning and decomposing waste compromised quality of air in surrounding communities. Communities were infested with flies, mosquitoes and vermin. Consequently, (73.5%) complained of persistent coughing, (65.1%) suffered from malaria, (72.6%) complained of persistent headaches and (62.2%) had frequent diarrhoea cases in stratum one. Respiratory problems were more pronounced at night possibly due to high humidity which hindered pollutants to easily escape. However, these cases reduced drastically in stratum two.

Conclusions

Unsanitary dumpsites in LMICs including Zambia are commonly used as solid waste disposal facilities as opposed to sanitary landfills and become predisposing factors for spread of diseases. Short proximities to dumpsites by unplanned human settlements cause serious environmental challenges leading to public health risks to surrounding communities.
Home Monitoring for Fever: An Inexpensive Screening Method to Prevent Household Spread of COVID-19
Authors: Kim Justin , Threadcraft Marcus A. , Xue Wei , Yue Sijie , Wenzel Richard P. , Southwick Frederick S.
Published: December 2021

The COVID-19 pandemic surge has exceeded testing capacities in many parts of the world. We investigated the effectiveness of home temperature monitoring for early identification of COVID-19 patients.

Study Design

We compared home temperature measurements from a convenience sample of 1180 individuals who reported being test positive for SARS-CoV-2 to an age, sex, and location matched control group of 1249 individuals who had not tested positive.

Methods

All individuals monitored their temperature at home using an electronic smartphone thermometer that relayed temperature measurements and symptoms to a centralized cloud based, de-identified data bank.

Results

Individuals varied in the number of times they monitored their temperature. When temperature was monitored for over 72 hours fever (> 37.6°C or 99.7°F or a change in temperature of > 1°C or 1.8°F) was detected in 73% of test positive individuals, a sensitivity comparable to rapid SARS-CoV-2 antigen tests. When compared our control group the specificity of fever for COVID-19 was 0.70. However, when fever was combined with complaints of loss of taste and smell, difficulty breathing, fatigue, chills, diarrhea, or stuffy nose the odds ratio of having COVID-19 was sufficiently high as to obviate the need to employ RTPCR or antigen testing to screen for and isolate coronavirus infected cases.

Conclusions

Our findings suggest that home temperature monitoring could serve as an inexpensive convenient screen for the onset of COVID-19, encourage earlier isolation of potentially infected individuals, and more effectively reduce the spread of infection in closed spaces.
Humoral and cellular immune responses to SARS CoV-2 vaccination in Persons with Multiple Sclerosis and NMOSD patients receiving immunomodulatory treatments
Authors: Bock H. , Juretzek T. , Handreka R. , Ruhnau J. , Löbel M. , Reuner K. , Peltroche H. , Dressel A.
Published: December 2021

Background

Vaccination against SARS CoV-2 results in excellent personal protection against a severe course of COVID19. In persons with Multiple Sclerosis (PwMS) vaccination efficacy may be reduced by immunomodulatory medications.

Objective

To assess the vaccination induced cellular and humoral immune response in PwMS receiving disease modifiying therapies.

Methods

In a monocentric observational study on PwMS and patients with Neuromyelitis optica we quantified the cellular and humoral immune responses to SARS CoV-2.

Results

PwMS receiving Glatirameracetate, Interferon-ß, Dimethylfumarate, Cladribine or Natalalizumab had intact humoral and cellular immune responses following vaccination against SARS CoV-2. B-cell depleting therapies reduced B-cell responses but did not affect T cell responses. S1P inhibitors strongly reduced humoral and cellular immune responses.

There was a good agreement between the Interferon gamma release assay and the T-SPOT assay used to measure viral antigen induced T-cell responses.

Conclusion

This study demonstrates that S1P inhibitors impair the cellular and humoral immune response in SARS CoV-2 vaccination, whereas patients receiving B-cell depleting therapies mount an intact cellular immune response. These data can support clinicians in counselling their PwMS and NMOSD patients during the COVID 19 pandemic.
Utilization of a SARS-CoV-2 Variant Assay for the Rapid Differentiation of Omicron and Delta
Authors: Barasch Nicholas , Iqbal Jameel , Coombs Marvin , Kazi Sofia , Wang-Rodriguez Jessica , Holodniy Mark , Gelman Michael
Published: December 2021

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant (B.1.1.529), creates a diagnostic vacuum, since differentiation of Omicron from Delta relies on relatively slow next generation sequencing (NGS) technology delaying epidemiologic understanding and therapeutic intervention. The RUO SARS-CoV-2 Variant Set 1 Test (RSCov2V1) RT-PCR for detection of spike gene N501Y, E484K and del69-70 was designed to differentiate Alpha from Beta and Gamma variants. While Delta lacks these three variants, Omicron has the N501Y and del69-70 mutation. We submitted 88 samples for RSCov2V1 identifying 9 samples with the N501Y and del69-70 mutations while all other samples (79) were negative for all three variants. 9/9 samples with the del69-70 and N501Y were identified by NGS to be Omicron while 47/47 other samples assessed by NGS were confirmed to be Delta family variants. We demonstrate here that an immediately available RT-PCR assay for detection of spike gene N501Y and del69-70 can be utilized to rapidly differentiate Omicron from Delta variants in the proper epidemiologic context
Direct, Indirect and Mixed Methods of Health Education By Nurse and Its Impact on Type 2 Diabetes Patients: A Literature review
Authors: Akoit Emilia Erningwati , Rumambo Pandin Moses Glorino
Published: December 2021

Background

Diabetes Mellitus (DM) is one of the chronic non-communicable diseases that has currently been very common, in particular Diabetes Mellitus type 2 that threatens public health. It has been included in the category of the six biggest causes of worldwide death, but self-control of treatment and obedience to self-care is still low. One of the influencing factors is related to the lack of knowledge. Providing ongoing health education is one of the solutions or efforts to strengthen knowledge in type 2 diabetes. The aim was to identify the various health education methods currently used by nurses and their impacts on type 2 DM. The method used is a literature review. The literature was searched on data based on Scopus, Web of Science, SAGE, CINAHL with the keywords “methods” or “interventions”, “education”, “health”, “nursing”, and “type 2 diabetes melitus. Fifteen (15) pieces of literature were considered to meet the criteria inclusion.

Results

Three (3) types of health education methods used by nurses were identified: 1). Direct health education refers to providing education by nurses to patients through training, coaching, interviews, Focus Group Discussion (FGD) and home visits; 2). Indirect Health Education - using mobile phones; 3). The mixed of direct health education and the use of mobile phone-based applications is carried out with the application of mobile health technology and nurse health coaching. The impact of providing health education by nurses to type 2 diabetic patients: increasing of knowledge, behavioral change on preventing diabetes complications, increasing self-efficacy, increasing self-care activities (diet management, physical activity, monitoring blood sugar levels, and foot care).

Conclusion

various methods of health education carried out by nurses currently have a positive impact on improving and increasing self-care management and efforts to prevent complications in type 2 diabetes.
Testing the phenotypic decanalization hypothesis: social determinants of hyperglycemia and type 2 diabetes in adult urban Argentinian population
Authors: Petino Zappala María Alejandra , Folguera Guillermo , Benitez-Vieyra Santiago
Published: December 2021

Type 2 diabetes, one of the major causes of death and disability worldwide, is characterized by problems in the homeostasis of blood glucose. Current preventive policies focus mainly on individual behaviors (diet, exercise, salt and alcohol consumption). Recent hypotheses state that the higher incidence of metabolic disease in some human populations may be related to phenotypic decanalization causing a heightened phenotypic variance in response to unusual or stressful environmental conditions, although the nature of these conditions is under debate. Our aim was to explore variability patterns of fasting blood glucose to test phenotypic decanalization as a possible explanation of heightened prevalence for type 2 diabetes in some groups and to detect variables associated with its variance using a nation-wide survey of Argentinian adult population. We found patterns of higher local variance for fasting glycemia associated with lower income and educational attainment. We detected no meaningful association of glycemia or its variability with covariates related to individual behaviors (diet, physical activity, salt or alcohol consumption). Our results were consistent with the decanalization hypothesis for fasting glycemia, which appears associated to socioeconomic disadvantage. We therefore propose changes in public policy and discuss the implications for data gathering and further analyses.
NetREx – Network-based Rice Expression Analysis Server for Abiotic Stress Conditions
Authors: Sircar Sanchari , Musaddi Mayank , Parekh Nita
Published: December 2021

Recent focus on transcriptomic studies in food crops like rice, wheat and maize provide new opportunities to address issues related to agriculture and climate change. Re-analysis of such data available in public domain supplemented with annotations across molecular hierarchy can be of immense help to the plant research community, particularly co-expression networks representing transcriptionally coordinated genes that are often part of the same biological process. With this objective we have developed NetREx, a Network based Rice Expression Analysis Server, that hosts ranked co-expression networks of Oryza sativa using publicly available mRNA-seq data across uniform experimental conditions. It provides a range of interactable data viewers and modules for analysing user queried genes across different stress conditions (drought, flood, cold and osmosis) and hormonal treatments (abscisic and jasmonic acid) and tissues (root and shoot). Subnetworks of user-defined genes can be queried in preconstructed tissue-specific networks, allowing users to view the fold-change, module memberships, gene annotations and analysis of their neighborhood genes and associated pathways. The webserver also allows querying of orthologous genes from Arabidopsis, wheat, maize, barley, and sorghum. Here we demonstrate that NetREx can be used to identify novel candidate genes and tissue-specific interactions under stress conditions and can aid in the analysis and understanding of complex phenotypes linked to stress response in rice. Available at: https://bioinf.iiit.ac.in/netrex/index.html
Reduced infectivity but increased immune escape of the new SARS-CoV-2 variant of concern Omicron
Authors: Hu Jie , Peng Pai , Wu Kang , Long Quan-xin , Chen Juan , Wang Kai , Tang Ni , Huang Ai-long
Published: December 2021

A new detected SARS-CoV-2 variant Omicron (B.1.1.529) had reported from more than 80 countries. In the past few weeks, a new wave of infection driven by Omicron is in progress. Omicron Spike (S) protein pseudotyped virus was used to determine the effect of S mutations on its capacity of infectivity and immune evasion. Our results showed the lower entry efficiency and less cleavage ability of Omicron than D614G variant. Pseudotype-based neutralizing assay was performed to analyze neutralizing antibodies elicited by previously infection or the RBD-based protein subunit vaccine ZF2001 against the Omicron variant. Sera sampled at around one month after symptom onset from 12 convalescents who were previously infected by SARS-CoV-2 original strain shows a more than 20-fold decrease of neutralizing activity against Omicron variant, when compared to D614G variant. Among 12 individuals vaccinated by RBD subunit vaccine, 58.3% (7/12) sera sampled at 15-60 days after 3rd-dose vaccination did not neutralize Omicron. Geometric mean titers (GMTs, 50% inhibitory dose [ID50]) of these sera against Omicron were 9.4-fold lower than against D614G. These results suggested a higher risk of Omicron breakthrough infections and reduced efficiency of the protective immunity elicited by existing vaccines. There are important implications about the modification and optimization of the current epidemic prevention and control including vaccine strategies and therapeutic antibodies against Omicron variant.