bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer survivorship and work
Authors: Wynn Philip , Murphy Elizabeth
Published: April 2019

The success of healthcare interventions in increasing survival rates of patients with the common cancers is one of the major achievements of modern medicine. Nevertheless, these conditions and their treatment, even with successful treatment outcomes, are recognized to lead to significant morbidity in some 25% of survivors. As diseases largely of age, the common cancers will increasingly be seen in working age populations as both survival and retirement ages in many countries increase. The challenges for those survivors developing immediate and enduring or late complications of treatment will increasingly be manifest in the proportion of workers experiencing consequent impairment of work ability. This chapter explores the nature of the potential long-term impact of cancer survivorship on work ability and the strategies and evidence base for workplace interventions seeking to mitigate these effects.
Vision and eye disorders
Authors: Mitchell Stuart J. , Pitts John
Published: April 2019

This chapter on eye and vision disorders sets out the effects of vision impairment on the ability to work and the effect of particular occupations on the health of the eyes and visual system. The main symptoms and functional effects of vision disorders are covered, and the effects of the main categories of ocular disease are explained, linking their symptoms and dysfunction to their effect on return to work, and also the adjustments that should be considered. The chapter also includes a brief summary of the key workplace design issues including lighting, display screen equipment, visual fatigue, and the employment of people with visual impairment. Finally, the commonest ocular hazards found in the workplace are described with consideration of provision of eye protection and first aid.
Building infection prevention programmes
Authors: Damani Nizam
Published: April 2019

This Chapter examines the global burden of healthcare-associated infections (HAIs) and its impact on healthcare facilities and on individuals. It also provides practical advice on how to successfully build an infection prevention and control (IPC) programme. It also summarizes how to provide low cost and cost-effective IPC services and lists unsafe, ritualistic, and wasteful IPC practices. The chapter examines the responsibilities both of healthcare facilities and healthcare workers in the prevention of HAIs. It also provides guidance on how to organize an IPC programme and discuss the role and responsibility of the infection control doctor and nurse/practitioner and outlines the core competencies required by the IPC team to perform their job effectively. It provides a summary of WHO core components to establish successful IPC programmes both at the national and healthcare facility level. Lists and web links to key IPC professional organizations and regulatory bodies are also provided.
Special pathogens
Authors: Damani Nizam
Published: April 2019

This section includes infection prevention and control (IPC) measures require for bloodborne viral infections, i.e. hepatitis B, hepatitis C, and HIV infection, gastrointestinal infections, i.e. Clostridium difficile associated diarrhoea, norovirus, and rotavirus, microorganisms spread via respiratory route, e.g. tuberculosis, influenza, respiratory syncytial virus (RSV), coronavirus (SARS and MERS-CoV), and Legionnaires’ disease. Separate parts deal with other common infections, e.g. varicella zoster virus (VZV), meningococcal infections, viral haemorrhagic fevers e.g. Lassa, Ebola, Marburg and Crimean-Congo haemorrhagic fever and human prion diseases, e.g. Creutzfeldt–Jakob disease (CJD). It also includes IPC advice on the management of scabies and infestation with lice and fleas.
Menu of care options
Authors: Semrau Maya , Burns Alistair , Lobo Antonio , Rikkert Marcel Olde , Robert Philippe , Schepens Mirjam , Stoppe Gabriela , Sartorius Norman
Published: April 2019

This chapter provides detailed information on the ‘Menu of care options’ that is attached to the International Schedule for the Integrated Assessment and Staging of Care for Dementia (IDEAL schedule). It provides recommended priorities for interventions (although not all possible interventions) for each of the different symptoms and severity patterns of dementia, as measured by the IDEAL schedule. The chapter includes an overview of the ‘Menu of care options’, a full copy of the ‘Menu of care options’ itself (which can be applied across countries worldwide), and five country example tables of the ‘Menu of care options’—for the Netherlands, Spain, Croatia, India, and Nigeria—illustrating the kind of interventions that may be relevant in countries with different levels of resources and experience. The chapter also includes a sub-chapter on the ‘Dementia Networking’ approach used for dementia care in the Netherlands.
Genetic explanations 2: adaptations in body size, shape, and composition
Authors: Bhopal Raj S.
Published: April 2019

Central body fat has been shown to be metabolically harmful while peripheral fat is neutral or even beneficial. The adipose tissue (compartment) overflow and the variable disease selection hypotheses aim to explain why South Asians tend to central adiposity. The former proposes it results from a small superficial subcutaneous fat compartment especially in the lower limbs, so excess energy is deposited as fat in central compartments. The evolutionary forces for this are presumed to be climatic. The latter proposes central fat deposits in South Asians are an evolutionary adaptation to combat gastrointestinal infections. South Asians’ also have small muscle mass, and small hips, for which there are no well-defined hypotheses. The small size at birth of South Asians may be relevant to all these observations. These differences in fat distribution, muscle and skeletal structure could explain a tendency to central (apple-shaped) obesity than generalized or peripheral obesity (pear-shaped).
Burn depth assessment
Authors: Dziewulski Peter George , Frew Quentin
Published: April 2019

Burn depth assessment is key assessing healing potential and risk of scarring. It informs wound management and surgical planning. The dynamic and evolving nature of a burn wound can make this difficult. Burns which are likely to take longer than 3 weeks to heal have a significantly increased risk of hypertrophic scar formation leading to functional and aesthetic morbidity. Assessing healing potential allows the treating clinician to optimize wound care and the need for surgical intervention.
Critical care of burns patients
Authors: Andrews Francis
Published: April 2019

The critical care management of burns patients requires a multidisciplinary collaborative approach to optimise the chances of patient survival. Early oral endotracheal intubation is essential if there is evidence of airway injury or injury that will affect breathing capacity, with early bronchoscopic evaluation of the upper and lower airway. Mechanical ventilation should follow strategies for acute respiratory distress syndrome (ARDS) management and weaning from ventilation requires an evidence-based approach; patients may require a tracheostomy as part of a weaning process. Burns patients are at an increased risk of hospital-acquired infection, especially ventilator acquired pneumonia and vascular catheter infection which should be treated rapidly. Attention to balanced sedation and nutrition are required to optimize the care of these patients. Another particular risk is acute renal failure due to rhabdomyolysis and careful fluid management is required to try and prevent this serious complication.
Ocular burns
Authors: Schrage Norbert , Gill Parneet
Published: April 2019

Clinical appearance, grading, and treatment of eye burns are explained. There is a brief and clear instruction how to treat best. The decisions to take, the medical products and drugs to use and the basic knowledge in ophthalmology of eye burns is detailed.
Perineal and genital burns
Authors: Warbrick-Smith James , Drew Peter
Published: April 2019

Burns to the perineal area and genitals are normally found in the context of widespread burn damage, and are uncommon in isolation. Causes, challenges, and the initial management of genital burns are discussed.
Occupational and physiotherapy
Authors: Glassey Nicole , Reeves Alison , Hedges Emily
Published: April 2019

Burns as a specialty requires a variety of therapeutic disciplines, and covers in-patient and out-patient care. The diversity of injury types, and subsequent therapeutic challenges, requires a unique approach to each patient. This chapter covers treatments and interventions and preventative methods.
Burns scar management
Authors: Middelkoop Esther , Fanstone Ruthann
Published: April 2019

Scars are an unwanted but expected result of wound healing. In order to prevent scar development, the type of scar and mechanisms that lead them to develop need to be understood. This chapter covers common types of scar, their maturation stages, preventative actions, and practical guidelines for scar management throughout their lifespan.
Star-forming regions at the periphery of the supershell surrounding the Cyg OB1 association - II. ISM kinematics and YSOs in the star cluster vdB 130 region
Authors: Sitnik T G , Egorov O V , Lozinskaya T A , Moiseev A V , Tatarnikov A M , Vozyakova O V , Wiebe D S
Published: April 2019

We present an observational study of small-scale feedback processes operating in the star-forming region located in the wall of the expanding supershell around the Cyg OB1 association. The interstellar gas and dust content and pre-stellar populations in the vicinity of the open star cluster vdB 130 are analysed based on new optical and IR observations performed with the 6-m (3D spectroscopic mapping in the [S ii] doublet) and 2.5-m (optical and NIR images) Russian telescopes along with the archival data of Spitzer and Herschel space telescopes. Analysing ionized gas kinematics and emission spectra, we discovered a compact region with supersonic motions. These motions may be caused either by stellar wind or a bipolar outflow from a protostellar disc. Young stellar objects were identified and classified in the area under study. Two star-forming regions were identified. One of them is a region of ongoing star formation in the head of the molecular cloud observed there and another one is a burst of star formation in the cloud tail.
Prevalence and Impact of Hepatitis E Virus Infection Among Persons With Chronic Hepatitis B Living in the US and Canada
Authors: McGivern David R , Lin Hsing-Hua S , Wang Junyao , Benzine Tiffany , Janssen Harry L A , Khalili Mandana , Lisker-Melman Mauricio , Fontana Robert J , Belle Steven H , Fried Michael W
Published: April 2019

Background

Patients with chronic hepatitis B virus (HBV) may experience spontaneous biochemical flares of liver disease activity. This study aimed to determine (i) the prevalence of prior and possible acute hepatitis E virus (HEV) infection among persons with chronic HBV and (ii) whether HEV infection is associated with liver disease flares among persons with chronic HBV.

Methods

Serum from a random sample of 600 adults in the Hepatitis B Research Network Cohort Study was tested for HEV RNA and anti-HEV IgM and IgG. Logistic regression models were used to estimate crude and adjusted odds ratios of anti-HEV prevalence for participant characteristics.

Results

Anti-HEV IgG and IgM seroprevalence was 28.5% and 1.7%, respectively. No participants had detectable HEV RNA. Of the 10 anti-HEV IgM+ participants, only 1 had elevated serum ALT at seroconversion. The odds of anti-HEV seropositivity (IgG+ or IgM+) were higher in older participants, males, Asians, less educated people, and those born outside the United States and Canada.

Conclusions

Acute HEV infection is a rare cause of serum ALT flares among persons with chronic HBV. The high seroprevalence of anti-HEV IgG among the chronic HBV patients is strongly associated with various demographic factors in this largely Asian American cohort.
The use of real-world data to address questions of patient safety
Authors: Yates Mark , Bechman Katie , Galloway James
Published: April 2019

Pharmacovigilance registries of biologics were established to evaluate the risk of adverse events that may be missed in trials due to shorter durations and homogeneous samples. This review will present the strengths and weaknesses of registry data in addressing patient safety issues. Since their inception, scope has broadened because registries represent a relatively inexpensive approach to answering many clinical questions, both research and non-research focused. They achieve high statistical power, allow direct comparability, and offer a level of detail about adverse events not possible with trial data. Registries have been central in clarifying the risk of infection and malignancy with anti-TNF therapy, despite the limitations of selection and channelling bias, incomplete case capture, unmeasured confounding, and the inability to infer causality. Routinely collected data from electronic health records and national audits offer alternative real-world resources, further assisting patients and clinicians in understanding the risks of biologic therapy choices.
Physical activity and mortality in patients with colorectal cancer: a meta-analysis of prospective cohort studies
Authors: Qiu Shumin , Jiang Chongmin , Zhou Lin
Published: April 2019

The association between physical activity (PA) and colorectal cancer (CRC) patients’ survival is inconsistent. We conducted a systematic review and meta-analysis to summarize published articles on this issue. We performed a comprehensive search of the PubMed, Embase, and Web of Science databases for relevant articles through 28 February 2018. The summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a random-effects model. Eighteen prospective cohort studies were included in the meta-analysis, with a total of 9257 cases of total mortality (TM) and 4015 cases of colorectal cancer-specific mortality (CRCSM) among 31 873 CRC survivors and 557 150 general populations. Among CRC survivors, the highest versus the lowest levels of prediagnosis PA showed decreased risks of TM (summary HR = 0.81, 95% CI: 0.76–0.87, I
2 = 1.8%) and CRCSM (summary HR = 0.85, 95% CI: 0.77–0.98, I
2 = 0), respectively. Significant risk reductions for TM and CRCSM were also demonstrated for postdiagnosis PA (HR = 0.63, 95% CI: 0.54–0.74; and HR = 0.64, 95% CI: 0.47–0.88, respectively). The inverse association between prediagnosis PA and cancer mortality was more pronounced for colon cancer than that for rectal cancer (P = 0.08). The summary HRs (95% CIs) of TM were 0.89 (0.83–0.97) and 0.79 (0.69–0.90) per 10 metabolic equivalent task-h/week increase in prediagnosis and postdiagnosis PA, respectively. Our meta-analysis provides comprehensive evidence that PA performed before or after cancer diagnosis is related to reduced mortality risk among CRC survivors.
Effect of metformin on the risk of prostate cancer in patients with type 2 diabetes by considering different confounding factors: a meta-analysis of observational studies
Authors: Wang Yongbo , Liu Xiaoxue , Yan Pengfei , Tang Juan , Chen Tong , Sun Yi , Zhou Wei , Bi Yongyi , Zhang Zhi-Jiang
Published: April 2019

Preclinical studies have suggested the antitumorigenic properties of metformin on prostate cancer; results from epidemiological studies remain contradictory. We aim to investigate the evidence of metformin and the risk of prostate cancer. PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies. Meta-analyses were carried out using the most fully adjusted hazard ratios and the corresponding 95% confidence intervals. Eighteen cohort studies and six case–control studies representing 2 009 504 male patients with type 2 diabetes mellitus were identified. The pooled HR of prostate cancer for metformin therapy was 0.97 (0.84–1.12) in case–control studies and 0.94 (0.79–1.12) in cohort studies, respectively. In cohort studies, we found that there was a modest association in studies with samples from Europe, but not in studies with samples from North America, Asia, and Oceania. In addition, metformin showed a slightly protective effect compared with sulfonylurea, but not insulin and other comparators. Meta-regression analyses found that obesity and prostate-specific antigen adjustment in statistical models may be the sources of heterogeneity. However, there were no significant differences in subgroups stratified by time-related biases, analytical approaches, types of risk estimates, study quality, publication year, and whether adjusted for smoking, alcohol abuse, hemoglobin A1c, diabetes duration, and other confounding factors. Our study showed that metformin therapy was not associated with the risk of prostate cancer in patients with type 2 diabetes mellitus. However, exploratory analyses suggest that metformin use may be protective in a certain subgroup of patients.
Immune-related pancreatitis associated with checkpoint blockade in melanoma
Authors: Kohlmann Johannes , Wagenknecht Daniel , Simon Jan-Christoph , Ziemer Mirjana
Published: April 2019

Recognizing and treating rare checkpoint inhibitor related adverse events may be a clinical challenge in melanoma therapy. One of rather rare affected organs is the pancreas. Immune-related pancreatitis is difficult to recognize due to its variable clinical characteristics. Asymptomatic elevations of serum lipase and/or amylase during therapy with immune-checkpoint blockade impede the diagnostic process. We present a patient who developed an immune-related pancreatitis within the first 4 months of immunotherapy. Treatment with high dose systemic glucocorticosteroids with very slow tapering over a total period of 6.5 months was necessary to keep the patient symptom free as well as to maintain long-term normalization of serum lipase. Checkpoint blockade related pancreatitis may occur as acute or chronic disease and may lack any radiographic signs. As in our case, very slow tapering of initially high dose systemic glucocorticosteroids seems to be a crucial requirement for lasting recovery. Even after successful treatment, late-onset secondary pancreatic insufficiency may occur and patients have to be followed up at regular intervals. Restarting immunotherapy after resolution of immune-related pancreatitis is possible but needs careful risk-benefit consideration.
MULTILAYERED OPTIC DISK HEMORRHAGE IN ADULTS WITHOUT A POSTERIOR VITREOUS DETACHMENT
Authors: Chen Xuejing , Tye Andrew , Shah Chirag P. , Baumal Caroline R.
Published: April 2019

Purpose:

To describe 2 cases of multilevel optic disk hemorrhages in adults without a posterior vitreous detachment.

Methods:

The findings on clinical examination, color fundus photography, fluorescein angiography, spectral domain optical coherence tomography at presentation and follow-up are presented.

Results:

Two patients ages 61 and 49 years presented with unilateral floaters secondary to microscopic vitreous hemorrhage. Their best-corrected visual acuities were 20/30 and 20/20, respectively. Fundus examination showed similar nasal crescent of peripapillary subretinal hemorrhage and superior flame hemorrhage. Fluorescein angiography for both patients showed blockage from hemorrhages without leakage. Spectral domain optical coherence tomography showed that the posterior hyaloid was attached at the macula and optic nerve for both patients. Both patients experienced spontaneous resolution of symptoms and signs.

Conclusion:

Previous reports of multilevel optic disk hemorrhages in adults variably suggested the necessity of a posterior vitreous detachment. This report illustrates that a posterior vitreous detachment confirmed on spectral domain optical coherence tomography is not a necessary prerequisite for this entity.
Coincidental Occurrence of Schnyder Corneal Dystrophy and Posterior Polymorphous Corneal Dystrophy Type 3
Authors: Dudakova Lubica , Skalicka Pavlina , Davidson Alice E. , Liskova Petra
Published: April 2019

Purpose:

To report a simultaneous occurrence of 2 rare corneal dystrophies.

Methods:

A 30-year-old man with a family history of posterior polymorphous corneal dystrophy type 3 (PPCD3) was invited for ophthalmic examination. Sanger sequencing of the coding regions and intron/exon boundaries of disease-associated genes, ZEB1 and UBIAD1, was performed.

Results:

The clinical findings suggested co-occurrence of PPCD3 and Schnyder corneal dystrophy in the proband. This dual diagnosis was supported by genetic findings. He was identified to carry a previously reported heterozygous nonsense mutation in ZEB1: c.2157C>G; p.(Tyr719*), and a novel heterozygous missense mutation in UBIAD1: c.569T>C; p.(Ile190Thr). The mother of the proband only carried c.2157C>G in ZEB1, and slit-lamp examination of her corneas showed endothelial lesions characteristic of PPCD3. The sister of the proband carried c.569T>C in UBIAD1 and had corneal crystal deposition in her anterior stroma consistent with the diagnosis of Schnyder corneal dystrophy.

Conclusions:

This case illustrates the coincidental occurrence of 2 rare and genetically distinct corneal dystrophies in a single patient. Furthermore, it highlights the need to perform comprehensive phenotyping in combination with appropriate genetic diagnostic testing to achieve an accurate diagnosis.
The Correlation Between Dry Eyes, Anxiety and Depression: The Sicca, Anxiety and Depression Study
Authors: Bitar Maya S. , Olson Daniel J. , Li Menbing , Davis Richard M.
Published: April 2019

Purpose:

To determine whether improvement in the severity of dry eye disease (DED) symptoms correlates with improvement in anxiety and depression.

Methods:

This prospective interventional case series recruited 45 adults with evidence of DED. Patients were administered the University of North Carolina Dry Eye Management Scale (DEMS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Personal Health Questionnaire Depression Scale (PHQ-8) to evaluate the severity of DED symptoms, anxiety, and depression, respectively. Standard of care treatment was provided for patients for 3 to 6 months, followed by re-administration of the DEMS, GAD-7, and PHQ-9 surveys. Statistical analysis was performed to assess the relationships between changes in survey scores.

Results:

Participants had a mean age of 65.5 (SD, 13.3) years, and 37 (84.6%) were women. Seven patients were lost to follow-up. DEMS and GAD-7 significantly improved from 5.8 ± 1.8 to 4.6 ± 0.2.2 (P = 0.01) and from 5.6 ± 5.5 to 3.3 ± 4.6 (P = 0.05), respectively. Changes in DEMS correlated with changes in PHQ-8 (ρ = 0.3 P = 0.05), but not with changes in GAD-7 (ρ = 0.2 P = 0.3). Changes in DEMS correlated with changes in both PHQ-8 and GAD-7 in the subgroup of patients without prior depression or anxiety diagnosis (ρ = 0.6, P = 0.002; ρ = 0.4, P = 0.02). A multivariate analysis showed that the relationship between DEMS, PHQ-8, and GAD-7 was independent of a prior diagnosis of depression or anxiety and of the presence of comorbidities.

Conclusions:

There is a significant correlation between the severity of DED and symptoms of depression and anxiety. Effective DED treatment could have a positive impact on the symptoms of depression and anxiety.
Medication Burden for Patients With Bacterial Keratitis
Authors: Ballouz Dena , Maganti Nenita , Tuohy Megan , Errickson Josh , Woodward Maria A.
Published: April 2019

Purpose:

To understand medication use and patient burden for treatment of bacterial keratitis (BK).

Methods:

A retrospective study was conducted examining medical records of adult patients with BK in an academic cornea practice. Data collected included medications used in the treatment of BK, dosing of medications, and the number and total duration of clinical encounters. Costs of medications were estimated using the average wholesale pharmacy price. Linear regression analysis was used to investigate associations of medication use with patient demographics and corneal culture results and reported with beta estimates (β) and 95% confidence intervals (95% CIs).

Results:

Forty-eight patients with BK (56% female) were studied. Patients were treated for a median of 54 days with 10 visits, 5 unique medications, 587 drops, and 7 prescriptions. The estimated median medication cost was $933 (interquartile range: $457–$1422) US dollars. Positive bacterial growth was significantly associated with more visits (β: 6.16, 95% CI: 1.75–10.6, P = 0.007), more days of treatment (β: 86.8, 95% CI: 10.8–163, P = 0.026), more prescribed medications (β: 2.86, 95% CI: 1.04–4.67, P = 0.003), and more doses of medications (β: 796, 95% CI: 818–1412, P = 0.012) compared with patients who did not undergo corneal scraping. Patients were prescribed 132 more drops of medication for every 10 years of older age (β: 132, 95% CI: 18.2–246, P = 0.024). Sex and income were not associated with medication burden or treatment length.

Conclusions:

Older patients and those with positive cultures incur the most medication burden in treatment of BK. Providers should be aware of medication usage and cost burden as it may affect compliance with treatment.
The Prevalence of Rectovaginal Colonization and Antibiotic Susceptibility Pattern of Streptococcus agalactiae in Pregnant Women in Al-Zahra Hospital, Rasht, Iran
Authors: Sahraee Shokoufeh , Milani Forozan , Atrkar Roushan Zahra , Hedayati Ch Mojtaba , Rostami Soodabeh , Shoja Saeed , Sheikhi Raheleh
Published: April 2019

Background

Maternal rectovaginal colonization with group B streptococcus (GBS) is a main risk factor for vertical transmission of GBS to newborns and life-threatening neonatal invasive diseases. The aim of this study was investigation of the prevalence of anorectal and vaginal colonization with GBS in late of pregnancy by culture-based and polymerase chain reaction (PCR) methods and antimicrobial susceptibility patterns of the GBS isolates in Rasht, Iran.

Methods

We analyzed 245 anorectal and vaginal swab samples separately from pregnant women at 35 to 37 weeks of gestation. All samples were cultured after enrichment in a selective Todd-Hewitt broth and then assayed by phenotypic characterizations and PCR method for cfb conserved gene. Antimicrobial susceptibility was performed using the Kirby–Bauer method.

Results

In total of 245 vaginal samples, 19 (7.8%) were positive based on culture method and 28 (11.4%) by PCR method. Among 245 rectal samples, 24 (9.8%) were positive by culture and 29 (11.8%) samples were positive by PCR. Of 245 pregnant women studied were found to have 9.7% GBS rectovaginal by culture and 15.9% by PCR methods. All GBS isolates were sensitive to ampicillin (77.2%) and vancomycin (72.2%) and were resistant to Penicillin (88.6%), ceftriaxone (75%), clindamycin (95.4%), azithromycin (86.3%), tetracycline (61.3%), erythromycin (47.7%), and levofloxacin (27.2%).

Conclusions

The results of this study indicate that the frequency of GBS isolation from rectal samples was higher than vaginal samples by both culture and PCR. Our study recommended intrapartum antibiotic prophylaxis against GBS infections based on ampicillin or vancomycin for GBS carriers in Rasht.
Comparing an Emergency Department–specific Antibiogram Versus Hospital-wide Antibiogram and Therapeutic Dilemmas for Uncomplicated Cystitis
Authors: Peyko Vincent , Daves Alexander , Eggleston Matthew
Published: April 2019

Background

The emergency department (ED) lies between the inpatient and outpatient worlds. Varying rates of antimicrobial resistance along with the volume of patients presenting to the ED with potential urinary tract infections make empiric antibiotic selection difficult but vital. However, simply referring to the guidelines may neither optimize therapy nor mitigate resistance.

Methods

This was a retrospective cohort study comparing antimicrobial sensitivities of women from home, diagnosed with uncomplicated cystitis and discharged home, versus sensitivities of an institution-wide antibiogram between September 1, 2016, and February 28, 2017. The primary outcome was determining whether there was a difference between Escherichia coli sensitivities in nonpregnant women older than 14 years, from home, being discharged home and diagnosed with uncomplicated cystitis versus an institution-specific antibiogram.

Results

Over the study period, 258 patients were evaluated for uncomplicated cystitis with 128 patients included in the final analysis as the retrospective cohort after 130 patients were excluded. Statistically significant differences between the retrospective cohort and institution-wide antibiogram were 80.5% versus 57% (P < 0.001) for amoxicillin/clavulanic acid, 85.9% versus 75% (P = 0.007) for cefazolin, 94.5% versus 86% (P = 0.008) for ceftriaxone, 96.1% versus 87% (P = 0.003) for cefepime, 97.5% versus 66% (P < 0.001) for levofloxacin, and 99.2% versus 95% (P = 0.032) for nitrofurantoin, respectively.

Conclusions

Our study shows differences between an ED-specific antibiogram and institution-wide antibiogram. Many common and guideline-recommended antimicrobials used to treat acute uncomplicated cystitis may not be appropriate. Compiling ED-specific antibiograms at all institutions may help to optimally guide therapy.
Disseminated Cryptococcal Infection in a Patient Receiving Acalabrutinib for Chronic Lymphocytic Leukemia
Authors: Wilson Paul A. , Melville Kathleen
Published: April 2019

A 61-year-old man with chronic lymphocytic leukemia (CLL) developed disseminated cryptococcal infection, diagnosed 7 months after commencement of acalabrutinib, a Bruton's tyrosine kinase inhibitor. To our knowledge, this is the first reported case of cryptococcal infection occurring in a patient being treated with acalabrutinib (with approximately 10 cryptococcal infections previously related to ibrutinib). Other unusual features included the development of mild hypercalcemia, which has been a rare complication of cryptococcal infection, and a probable immune reconstitution inflammatory syndrome–like response to extensive pulmonary cryptococcal infection. The case further emphasizes the need for vigilance for possible invasive fungal infection (particularly Cryptococcus) in patients treated with Bruton's tyrosine kinase inhibitors.
A Decision Algorithm Is Not Superior to Clinician Judgment to Determine Need for Peripheral vs Central Venous Catheterization
Authors: Panter Melissa , Olson DaiWai M. , Stutzman Sonja E. , Aiyagari Venkatesh
Published: April 2019

Background: Venous access, via a midline peripheral catheter (midline) or a peripherally inserted central catheter, is used regularly in the neurointensive care unit as a means for prolonged infusion of drugs or medications. There is little research on how to choose the appropriate access device to use in this setting. The aim of this study is to trial an algorithm to assist clinicians in determining which device to use, as a way to reduce patient complications such as central line–associated bloodstream infection and deep vein thrombosis. Methods: This quality improvement initiative included both retrospective and prospective data. A retrospective chart review was performed, and data were analyzed for variables associated with decision making between the 2 access devices. An algorithm was developed to assist clinicians with deciding between midline access and peripherally inserted central catheter access. Results: A total of 325 charts were reviewed (126 retrospective and 109 prospective). Results show no significant differences in the demographic characteristics of either group. Before intervention, clinicians chose the correct access device 86% of the time, whereas after the intervention, clinicians chose the correct device 78% of the time (P = .06). Conclusion: The results of this study indicate that the quality improvement intervention and algorithm decision-making tool did not improve accuracy of use of access devices.
Clinical Characteristics of Acute Vestibular Neuritis According to Involvement Site
Authors: Lee Jung-Yup , Park Jin Su , Kim Min-Beom
Published: April 2019

Objective:

To analyze the clinical characteristics of acute vestibular neuritis (AVN) according to involvement site.

Study Design:

Retrospective chart analysis.

Setting:

Tertiary referral hospital.

Patients/Interventions:

Over a period of 3 years, we reviewed 133 cases of AVN. Patients were classified into three groups: 1) total vestibular neuritis (superior and inferior vestibular nerve involvement [TVN]); 2) superior vestibular neuritis (superior vestibular nerve involvement [SVN]); and 3) inferior vestibular neuritis (inferior vestibular nerve involvement [IVN]).

Main Outcome Measure:

We analyzed the clinical course and results of vestibular function tests (video-nystagmography, video head impulse test [vHIT], caloric test, and cervical vestibular evoked myogenic potential).

Results:

In the study, there were 39.9% TVN cases, 48.1% SVN cases, and 12% IVN cases. The number of days to spontaneous nystagmus remission, hospital duration, and follow-up period were shorter in the IVN group than in the SVN and TVN groups. The symptom onset period was longer in the IVN group than in the SVN and TVN groups. Spontaneous nystagmus and head shaking nystagmus amplitude were smaller in the IVN group than in the SVN and TVN groups. Concordance of results between the caloric test, cervical vestibular evoked myogenic potential, and vHIT was relatively low in the IVN group.

Conclusion:

The IVN group had a shorter clinical course and weaker nystagmus in comparison with the TVN and SVN groups. The use of additional vHIT in the diagnosis of AVN can help provide a more accurate diagnosis of the rare subtype of IVN, which can be confused with various central lesions.
Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: a systemic review and meta-analysis
Authors: Ning Longui , Liu Rongqiang , Lou Xinhe , Du Haojie , Chen Wenguo , Zhang Fenming , Li Sha , Chen Xueyang , Xu Guoqiang
Published: April 2019

Although clinical studies have shown possible links of Helicobacter pylori infection with the development of nonalcoholic fatty liver disease (NAFLD), the results remain controversial. The aim of this meta-analysis is to investigate the association between H. pylori infection and NAFLD. A comprehensive search of relevant studies was performed up to November 2018. Data on H. pylori infection in NAFLD patients and controls were extracted. Odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Twelve studies involving 27 400 NAFLD patients and 60 347 controls were included. The pooled overall OR of H. pylori infection in NAFLD patients compared with controls was 1.36 (95% CI: 1.22–1.53, I
2=89.6%, P=0.000). Meta-regression and subgroup analysis showed that the sample size and the case–control ratio may have accounted for some of the heterogeneity. When stratified by publication year, the diagnostic method used for H. pylori, and Newcastle–Ottawa Scale scores, the OR remained significant. However, possible publication bias was observed. Of the 12 studies, six had carried out multivariable analysis after adjusting for potential confounders. The pooled results from these studies still indicated a higher risk of NAFLD in patients infected with H. pylori (OR=1.17, 95% CI: 1.01–1.36, I
2=72.4%, P=0.003). There is a 36% increased risk of NAFLD in patients with H. pylori infection. Further studies are warranted to investigate whether eradication of H. pylori is useful in the prevention and treatment of NAFLD.
When to intervene for donor-specific antibody after heart transplantation
Authors: Njue Faith , Chih Sharon
Published: April 2019

Purpose of review

Posttransplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) represent a complex area in heart transplantation with nonstandardized practice and paucity of clinical data to guide optimal management.

Recent findings

De novo DSA after heart transplantation is common and associated with rejection, cardiac allograft vasculopathy, allograft failure, and mortality. Advances in methods for HLA antibody detection have enabled identification of DSA with high precision and sensitivity. The detection of HLA antibodies must, however, be interpreted within appropriate laboratory and clinical contexts; it remains unclear which DSA are associated with greatest clinical risk. Increased antibody and clinical surveillance as well as optimization of maintenance immunosuppression are required for all patients with DSA. Antibody-directed therapies are reserved for patients with allograft dysfunction or rejection. Treatment of DSA may also be considered in asymptomatic high-risk patients including those in whom DSA arise de novo posttransplant, is persistent, high titer, or complement activating. The impact of DSA reduction and removal on long-term clinical outcomes remains unknown.

Despite improvements in DSA detection, identification, and characterization, best therapeutic strategies are unclear. Prospective multicenter studies are needed to develop effective standardized approaches for DSA management in heart transplantation.
Current practices in deceased organ donor management
Authors: Patel Madhukar S. , Abt Peter L.
Published: April 2019

Purpose of review

Optimizing the management of deceased organ donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, and respiratory management; and the potential of various additional donor therapies.

Recent findings

Protocol-based critical care after the determination of brain death has the potential to substantially increase the quantity and improve the quality of organs available for transplantation. Close hemodynamic monitoring with timely resuscitation using isotonic fluid replacement as well as adjunctive vasoactive and hormone replacement therapy in the persistently hemodynamically unstable donor is recommended. Convincing evidence suggests that mild therapeutic hypothermia of the donor can be adopted to reduce delayed graft function in the renal transplant recipient.

There continues to be a limited number of current published reports pertaining to deceased organ donor management, with many practices still based on consensus statements. Recent endorsement and recommendations for conducting donor intervention research have provided a framework for future studies, which have potential to lead to the publication of quality results so that more evidence-based guidelines can be developed.
HIV-Related Deaths in Nairobi, Kenya: Results From a HIV Mortuary Surveillance Study, 2015
Authors: Nyagah Lilly M. , Young Peter W. , Kim Andrea A. , Wamicwe Joyce , Kimani Maureen , Waruiru Wanjiru , Rogena Emily , Oduor Johansen , Walong Edwin , Waruru Anthony , Oyugi Julius , Downer Marie , De Cock Kevin M. , Sirengo Martin
Published: April 2019

Background:

Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya.

Methods:

Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples.

Results:

Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression.

Conclusions:

HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.
Changes in Disparities in Estimated HIV Incidence Rates Among Black, Hispanic/Latino, and White Men Who Have Sex With Men (MSM) in the United States, 2010–2015
Authors: McCree Donna Hubbard , Williams Austin M. , Chesson Harrell W. , Beer Linda , Jeffries William L. , Lemons Ansley , Prather Cynthia , Sutton Madeline Y. , McCray Eugene
Published: April 2019

Background:

During 2008–2015, the estimated annual HIV incidence rate in the United States decreased for each transmission risk category, except for men who have sex with men (MSM). Racial/ethnic disparities exist, with higher incidence rates for Black and Hispanic/Latino MSM.

Setting:

This analysis examines changes, 2010–2015, in disparities of HIV incidence among Black, Hispanic/Latino and White MSM.

Methods:

We compared results from the rate ratio, rate difference, weighted and unweighted index of disparity, and population attributable proportion. We calculated incidence rates for MSM using HIV surveillance data and published estimates of the MSM population in the United States. We generated 95% confidence intervals for each measure and used the Z statistic and associated P values to assess statistical significance.

Findings:

Results from all but one measure, Black-to-White rate difference, indicate that racial/ethnic disparities increased during 2010–2015; not all results were statistically significant. There were statistically significant increases in the Hispanic/Latino-to-White MSM incidence rate ratio (29%, P < 0.05), weighted index of disparity with the rate for White MSM as the referent group (9%, P < 0.05), and the population attributable proportion index (10%, P < 0.05). If racial/ethnic disparities among MSM had been eliminated, a range of 55%–61% decrease in overall MSM HIV incidence would have been achieved during 2010–2015.

Conclusions:

A large reduction in overall annual HIV incidence among MSM can be achieved by eliminating racial/ethnic disparities among MSM. Removing social and structural causes of racial/ethnic disparities among MSM can be effective in reducing overall annual HIV incidence among MSM.
Is There a Role for Natural Antibodies in Rejection Following Transplantation?
Authors: Zorn Emmanuel , See Sarah B.
Published: April 2019

Antibody-mediated rejection continues to hinder long-term survival of solid organ allografts. Natural antibodies (Nabs) with polyreactive and autoreactive properties have recently emerged as potential contributors to antibody-mediated graft rejection. This review discusses Nabs, their functions in health and disease, their significance in rejection following kidney, heart, and lung transplantation, and their implication in serum reactivity to key antigens associated with rejection. Finally, potential effector mechanisms of Nabs in the context of transplantation are explored.
Long-term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract Malformations: A Multicenter Study
Authors: Marchal Stéphane , Kalfa Nicolas , Iborra François , Badet Lionel , Karam Georges , Broudeur Lucas , Branchereau Julien , Abdo Nicolas , Thuret Rodolphe
Published: April 2019

Background.

Renal insufficiency can occur in patients with congenital lower urinary tract malformations (LUTM) even when managed during infancy. Data in the current literature concerning this subject remain sparse. The aim of this study was to report the feasibility and long-term results of renal transplantation during adulthood in patients with a congenital LUTM.

Methods.

A retrospective multicenter study from 3 French renal transplant centers was conducted, including 123 transplantations on 112 patients with LUTM (1996–2016). Graft survival, patient survival, and complications were analyzed. Results were stratified according to the underlying uropathy and the type of initial management during childhood or before transplantation.

Results.

In this study, patients suffering from posterior urethral valves (n = 49), spina bifida (n = 21), central neurogenic bladder (n = 13), bladder exstrophy (n = 14), prune belly syndrome (n = 12), Hinman syndrome (n = 6), urogenital sinus (n = 4), and other pathologies (n = 4) were included. The mean age at transplantation was 32.1 years old (±11.2). The mean follow-up period was 7.2 years. Patient survival at 1, 5, 10, and 15 years was 97.4%, 93.0%, 89.4%, and 80.0%, respectively. Graft survival at 1, 5, 10, 15, and 20 years was 96.6%, 87.6%, 77.3%, 60.6%, and 36.4%, respectively. Enterocystoplasty and continent urinary diversions exposed grafts to more frequent acute pyelonephritis (P = 0.02). There was no difference in graft survival when transplantation was performed on an enterocystoplasty or urinary diversions compared with a native bladder, provided a well-conducted bladder management.

Conclusions.

Even though enterocystoplasty and continent urinary diversions exposed grafts to more frequent acute graft pyelonephritis, patient and graft survival rates in LUTM at 10 years were similar to other kidney transplantations on native bladders.
Cross-talk of cutaneous beta human papillomaviruses and the immune system: determinants of disease penetrance
Authors: Venuti Assunta , Lohse Stefan , Tommasino Massimo , Smola Sigrun
Published: April 2019

Human papillomaviruses (HPVs) infect the epithelia of skin or mucosa, where they can induce hyperproliferative lesions. More than 220 different HPV types have been characterized and classified into five different genera. Mucosal high-risk HPVs are causative for cancers of the anogenital region and oropharynx. Clinical data from patients with the rare genetic disorder epidermodysplasia verruciformis (EV) indicate that genus beta-HPVs cooperate with ultraviolet (UV) radiation in the development of cutaneous squamous cell carcinoma. In addition, epidemiological and biological findings indicate that beta-HPV types play a role in UV-mediated skin carcinogenesis also in non-EV individuals. However, the mechanisms used by these cutaneous viruses to promote epithelial carcinogenesis differ significantly from those of mucosal HPVs. Recent studies point to a delicate cross-talk of beta-HPVs with the cell-autonomous immunity of the host keratinocytes and the local immune microenvironment that eventually determines the fate of cutaneous HPV infection and the penetrance of disease. This review gives an overview of the critical interactions of genus beta-HPVs with the local immune system that allow the virus to complete its life cycle, to escape from extrinsic immunity, and eventually to cause chronic inflammation contributing to skin carcinogenesis.

This article is part of the theme issue ‘Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses’.