bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential nonpharmacological interventions to prevent frailty among elderly in low- and middle-income countries
Authors: Ara Rifat , Monisha Umme Kulsum , Nova Tashnova Jahan , Chowdhury Sreshtha , Nabi Mohammad Hayatun , Hawlader Mohammad Delwer Hossain
Published: January 2022

Background:

Frailty syndrome is a medical condition defined by a progressive loss of function that usually begins beyond 65 and necessitates assistance with daily activities. There are both pharmacological and nonpharmacological approaches to prevent frailty. The purpose of this systematic review is to investigate viable nonpharmacological therapies for reducing frailty among the elderly in low- and middle-income countries, to develop an appropriate guideline to determine the applicability of these nonpharmacological interventions in various feasible settings.

Methods:

Two independent researchers will explore 5 electronic databases for relevant and promising studies. The selected articles will be subjected to a full-text examination following the initial screening. Two independent authors will analyze the risk of bias using the Cochrane risk of bias assessment tool. The review findings on various nonpharmacological approaches to prevent frailty will be presented as a narrative synthesis. There will be a sensitivity analysis and an assessment of study heterogeneity if possible.

Results and conclusion:

The systematic review protocol has been evaluated and approved by the institutional review board of North South University. The preferred reporting items for systematic review and meta-analysis protocol recommendations for precisely reporting health care interventions and the Cochrane group standards will be strictly followed in this systematic review protocol.

PROSPERO Registration number:

CRD42021290417
The improvement of the lower limb exoskeletons on the gait of patients with spinal cord injury
Authors: Xue Xiali , Yang Xinwei , Tu Huan , Liu Wanna , Kong Dezhi , Fan Zhonghe , Deng Zhongyi , Li Ning
Published: January 2022

Background:

Spinal Cord Injury is a severely disabling disease. In the process of Spinal Cord Injury rehabilitation treatment, improving patients’ walking ability, improving their self-care ability, and enhancing patients’ self-esteem is an important aspect of their return to society, which can also reduce the cost of patients, so the rehabilitation of lower limbs is very important. The lower limb exoskeleton robot is a bionic robot designed according to the principles of robotics, mechanism, bionics, control theory, communication technology, and information processing technology, which can be worn on the lower limb of the human body and complete specific tasks under the user's control. The purpose of this study was to evaluate the effect of the lower limb exoskeleton on the improvement of gait function in patients with spinal cord injury.

Methods:

The following electronic databases will be searched from inception to January 2022: PubMed, the Cochrane Library, Embase, Scopus, EBSCO, Web of Science, China National Knowledge Infrastructure, WanFang Data, Weipu Electronics. In addition, reference lists of the included studies were manually searched to identify additional relevant studies. Randomized controlled trials were collected to examine the effect of lower limb exoskeletons on lower limb functional recovery in spinal cord injury patients. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of lower limb exoskeletons on the upper limb function of spinal cord injury patients. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing.

Results:

The results will provide evidence for judging whether lower limb exoskeletons are effective and safe in improving lower limb function in patients with spinal cord injury.

Conclusion:

Our study will provide reliable evidence for the effect of lower limb exoskeletons on the improvement of lower limb function in spinal cord injury patients.

INPLASY registration number:

INPLASY202180095.
Edematous wall thickening of the gallbladder induced by hyperthyroidism
Authors: Koyama Katsumasa , Anno Takatoshi , Kawasaki Fumiko , Nishino Ken , Kawamoto Hirofumi , Kaneto Hideaki , Tomoda Koichi
Published: January 2022

Rationale:

Hyperthyroidism, such as Basedow disease, causes fluid retention, although the common cause is volume overload due to congestive heart failure. In addition, hyperthyroidism and Basedow disease are known to cause pulmonary hypertension. Edematous thickening of the gallbladder wall is caused by venous blood congestion. The feature of edematous wall thickening of the gallbladder on abdominal computed tomography (CT) is subserosal edema and is often accompanied by a periportal collar sign.

Patient concerns:

A 30-year-old woman was referred to our hospital because of liver dysfunction, edematous gallbladder wall thickening, and fluid retention. In addition, the patient developed hyperthyroidism and heart failure. Enhanced abdominal CT revealed edematous wall thickening of the gallbladder and a periportal collar sign.

Diagnosis:

We suspected that fluid retention and congestion were caused by hyperthyroidism and Basedow disease.

Interventions:

On admission, we started thiamazole therapy for Basedow disease, and her thyroid hormone levels normalized.

Outcomes:

Abdominal CT revealed disappearance of edematous wall thickening of the gallbladder, which was likely associated with an improvement in thyroid function. The patient was discharged 10 days after admission.

Lessons:

We encountered a case of hyperthyroidism and Basedow disease accompanied by edematous wall thickening of the gallbladder and various fluid retentions as the first symptoms. Such edematous wall thickening of the gallbladder and various fluid retentions were reduced, together with the improvement of hyperthyroidism.
Prognostic value of the lactate/albumin ratio for predicting mortality in patients with pneumosepsis in intensive care units
Authors: Erdoğan Murat , Findikli Hüseyin Avni
Published: January 2022

The lactate/albumin (L/A) ratio correlates with Acute Physiology and Chronic Health Evaluation 2 (APACHE-2) and Sequential Organ Failure Assessment (SOFA) scores. This study examined whether the L/A ratio has prognostic value in a larger group of critically ill (adult) patients admitted to an intensive care unit (ICU) due to pneumosepsis.

This retrospective study analyzed the data of 273 patients with pneumosepsis admitted to the Internal Medicine ICU of Adana City Training and Research Hospital between 2018 and 2020. Patients diagnosed with pneumosepsis were included in the study. The data were obtained from the hospital system. Patients who had cancer, who were pregnant, and patients whose necessary data could not obtain for the study were excluded from the study.

The L/A ratio was superior to lactate or albumin alone as a predictor of mortality. Furthermore, this result was valid for patients with kidney and hepatic dysfunction. A correlation occurred between the L/A ratio and APACHE-2 and SOFA scores in patients with pneumosepsis.The L/A ratio can be an independent predictor of mortality in patients with pneumosepsis and patients with pneumosepsis with renal and hepatic dysfunction. The L/A ratio correlated positively with lactate levels and APACHE-2 and SOFA scores but negatively with albumin levels.
Associations between red cell distribution width and outcomes of adults with in-hospital cardiac arrest
Authors: Cheng Yanwei , Peng Hailin , Zhang Jiange , Zhu Juan , Xu Lijun , Cao Xue , Qin Lijie
Published: January 2022

Previous studies found that high red cell distribution width (RDW) value is associated with poor outcomes among out-of-hospital cardiac arrest survivors. The aim of this study was to investigate whether post-ROSC RDW value was associated with survival and neurological outcomes of in-hospital cardiac arrest (IHCA) patients achieving return of spontaneous circulation (ROSC) but remaining critically ill.

This retrospective single-center observational study included IHCA adults with sustained ROSC between January 1, 2017 and January 1, 2021 at an academic medical center in China. PostROSC RDW values were measured within 1 hour after sustained ROSC. The primary outcome was survival to hospital discharge and the secondary outcome was favorable neurological outcome at hospital discharge. The associations between postROSC RDW value and outcomes among IHCA patients with ROSC were evaluated by using multivariate logistic regression.

A total of 730 patients with sustained ROSC following IHCA were ultimately included in this study. Of whom 194 (26.6%) survived to hospital discharge and 116 (15.9%) had a favorable neurological outcome at hospital discharge. In multivariable logistic regression analysis, lower postROSC RDW value was independently associated with survival to hospital discharge (odds ratio 0.19, 95% confidence interval 0.15–0.63, P = .017, cut-off value: 15.5%) and favorable neurological outcome at hospital discharge (odds ratio 0.23, 95% confidence interval 0.07–0.87, P < .001, cut-off value: 14.6%). Other independent factors including younger age, initial shockable rhythm, shorter total cardiopulmonary resuscitation duration and post-ROSC percutaneous coronary intervention were also associated with survival to hospital discharge. Regarding favorable neurological outcome at hospital discharge, significant variables other than the aforementioned factors included postROSC targeted temperature management and absence of pre-existing neurological insufficiency.

Low postROSC RDW value was associated with survival to hospital discharge and favorable neurological outcome at hospital discharge.
Transmission of multidrug-resistant Mycobacterium tuberculosis in Wuhan, China
Authors: Duan Qionghong , Zhang Zhengbin , Tian Dan , Zhou Meilan , Hu Yanjie , Wu Jun , Wang Tiantian , Li Yuehua , Chen Jun
Published: January 2022

How multidrug-resistant tuberculosis (MDR-TB) spreads and expands in Wuhan population is not clear. The study aimed to determine the transmission patterns of MDR-TB in Wuhan city, China, including 149 patients with MDR-TB.

Tuberculosis isolates were genotyped by deletion-targeted multiplex polymerase chain reaction, mycobacterial interspersed repetitive unit-variable number tandem repeat typing, and sequencing of drug resistance-associated genes. The risk factors of genomic-clustering were analyzed with logistic regression. The genomic-clustering patients were deeply investigated.

The analysis identified 111 unique and 11 clustered genotypes (38 isolates). The clustering rate was 25.50% and the minimum estimate proportion of recent transmission was 18.12%. Two clusters (5 isolates) shared the same mutation, the remain 9 clusters (33 isolates) had different mutation. Logistic regression showed that older than 60 years (adjusted OR 2.360, 95% CI:1.052-5.292) was an independent factor associated with the genomic-clustering of MDR-TB. Among the 38 genomic-clustering cases, 14 cases had epidemiological transmission links. The most common type of transmission link was social contact.

The local transmission of MDR-TB in Wuhan was really an issue. The elderly population might be the high-risk groups for transmission of MDR-TB, and the community or public transportation might be the main transmission places.
Pre-operative embolization and excision of vagal schwannoma with rich vascular supply
Authors: Xu Tao , Liu Yue , Li Siyuan , Zheng Lei
Published: January 2022

Rationale:

Schwannomas are benign tumors wrapped in the nerve sheath and can originate from the myelin sheath of the cranial nerve. In previous literature reports, most of the tumors were solid tumors, which can be removed only by surgery. This case report describes a unique case of vagal schwannoma, which, unlike previous cases, involves a dominant arterial supply, and discusses the pre-operative evaluation, relevant radiographic findings, and surgical process of the case in detail.

Patient concerns:

A 31-year-old woman sought treatment for pain in the left side of the neck when turning her head. A mass on the left side of the neck was found on enhanced computed tomography with a maximum diameter of 6.8 cm, along with multiple tortuous, thickened vascular shadows, and pressure on the left pharyngeal cavity.

Diagnosis:

The pathological results showed schwannoma.

Interventions:

Considering the unusual size of the tumor and thickened blood vessels revealed by pre-operative computed tomography, general anesthesia and biopsy were conducted first to confirm the diagnosis. Excessive bleeding occurred during the process; thus, the tumor was only partially removed before the wound closed after hemostasis. Digital subtraction angiography indicated that the tumor was supplied by multiple arteries, and the tumor was removed by pre-operative embolization plus intra-operative removal.

Outcomes:

Combined with embolization and surgical resection, the tumor was completely removed, the nerve was partially preserved, and the patient had postoperative hoarseness.

Lesson:

The present case indicates the possibility of vascularly supplied vagal schwannoma; thus, it is necessary to conduct pre-operative digital subtraction angiography.
Evaluation of a Nurse-led Aftercare Intervention for Patients With Head and Neck Cancer Treated With Radiotherapy and Cisplatin or Cetuximab
Authors: Braat Cora , Verduijn Gerda M. , van der Stege Heleen A. , Offerman Marinella P.J. , Peeters Mariëlle A.C. , van Staa AnneLoes , Oldenmenger Wendy H.
Published: January 2022

Background

The supportive needs for head and neck cancer (HNC) patients during the vulnerable period after treatment are not always met. Therefore, more professional support regarding physical, social, and psychological care as well as lifestyle is recommended.

Objective

This study is an evaluation of a nurse-led aftercare intervention to support patients recovering from HNC treatment.

Methods

Intervention group (IG) participants received 2 extra consultations from a nurse practitioner 3 and 9 months after treatment of HNC. A holistic conversational tool, the Self-Management Web, was developed to guide the nurse through the conversation. Primary outcomes were health-related quality of life (HRQoL) and quality of patient-centered care. A secondary outcome was self-management skills.

Results

Twenty-seven patients were included in the IG, and 28 were included in the control group. Differences in HRQoL and self-management between the IG and the control group were not statistically significant. For the IG, all domains of the Self-Management Web were perceived important and addressed by the nurse practitioner.

Conclusion

This holistic nurse-led aftercare intervention was highly appreciated by HNC patients. Although the intervention met the need for support in recovery after treatment, it did not improve HRQoL or self-management skills.

Implications of Practice

For both nurses and patients, the intervention is feasible and acceptable in daily practice. Self-management support for patients after their cancer treatment is of added value and has potential to improve the quality of regular follow-up care.
High Rate of Emergency Department Care in Youth With Abdominal Pain–Associated Functional Gastrointestinal Disorders
Authors: Friesen Alec S. , Livitz Michelle , Glynn Earl F. , Schurman Jennifer V. , Colombo Jennifer M. , Friesen Craig A.
Published: January 2022

Objectives

The primary objective was to describe patterns of care delivery locations in youth with abdominal pain–associated functional gastrointestinal disorders (AP-FGID) and assess for differences in patterns of care delivery by sex and race. A secondary objective was to describe cost variability within the emergency department (ED).

Methods

Data were obtained using a large, single-vendor database that extracts and deidentifies data from the electronic health record across the outpatient, ED, and inpatient continuum of care. We evaluated patients 8 to 17 years of age seen over an 8-year period for a priority 1 diagnosis of an AP-FGID. Data collected included age, sex, race, encounter location, and total cost of ED encounters. We specifically assessed how often patients seen in the ED were also seen in outpatient or inpatient settings.

Results

A total of 53,750 patients (64% female; mean age, 13.3 ± 2.8 years) were identified and assessed. The most common location of care was the ED (48.8%) followed by the outpatient setting (46.2%). Of patients seen for a priority 1 AP-FGID diagnosis in the ED, only 3.7% were seen for a priority 1 diagnosis in the outpatient setting, and only 1% were seen in an inpatient setting. Overall, females received 42.5% of their care and males received 44.8% of their care in the ED. The overall rate of ED care was 66.9% for Hispanic, 61.5% for African American, 55.1% for Asian, 46.6% for Native American, and 36.9% for Caucasian patients.

Conclusions

The ED is the most common location for care for youth with AP-FGIDs and, for the majority, seems to be the only location. This seems to be particularly true for Hispanic and African American patients. Given the often complex psychosocial needs of this patient group, processes need to be developed to transition these patients into the outpatient setting, ideally to programs specializing in chronic pain.
Ankle–Brachial Index for the Assessment of Peripheral Arterial Disease in the Emergency Department
Authors: Street Tiffany K.
Published: January 2022

Peripheral arterial disease, both acute and chronic ischemia, is a clinical diagnosis encountered in the emergency department setting. The emergency nurse practitioner should be able to recognize the clinical presentation, understand the diagnostic tools available to make an appropriate clinical diagnosis, and know how to coordinate the appropriate treatment plan with a vascular surgeon. Timely and appropriate diagnosis of limb-threatening arterial disease is imperative to restore arterial perfusion and prevent the loss of the lower extremity.
Tranexamic Acid for the Treatment of Acute Gastrointestinal Bleeding in a Jehovah's Witness Patient on Apixaban and Dual Antiplatelet Therapy
Authors: Yurukov Vladimir V. , Boykin Tracy , Rech Megan A.
Published: January 2022

Life-threatening bleeding can be challenging to manage, especially in patients who reject allogeneic transfusions for religious or personal reasons. Tranexamic acid (TXA) has been successfully used to treat acute bleeding in multiple settings with varying severity, including trauma, women with postpartum hemorrhage, hemoptysis, and epistaxis, with minimal adverse effects. The purpose of this case report is to describe the use of TXA to aid in achieving hemostasis in a Jehovah's Witness patient on apixaban with a life-threatening gastrointestinal (GI) bleed. An 80-year-old female Jehovah's Witness patient on apixaban for lower extremity deep vein thrombosis presented to the emergency department with 8 hr of GI bleeding. On presentation, she was hemodynamically unstable, requiring a norepinephrine infusion. She refused any blood-derived products or anticoagulant reversal agents derived from human or animal products. One 1-g dose of intravenous TXA was given as a bolus for more than 10 min, followed by another 1-g dose for more than 8 hr. The patient achieved successful hemostasis allowing for further inpatient management and eventually was discharged from the hospital. This case describes a life-threatening GI bleed in a Jehovah's Witness patient who was successfully treated using TXA.
Differential Diagnosis of Lesions
Authors: Milo Razel B.
Published: January 2022

There have been many uncertainties during the coronavirus pandemic. New studies emerge about new symptoms associated with the virus that include dermatological disorders. Lesions with an unknown cause can be a challenge to diagnose and treat. Some lesions have nonspecific symptoms associated with viral infections, immune-mediated reactions, autoimmune disease, malignancy, radiation, immunizations, and sarcoidosis. These lesions may be associated with erosions and bullae that can involve the mucosa. Nurse practitioners must be aware of the clinical manifestations of various lesions and need to determine when patients should be hospitalized or managed in the outpatient setting.
Emergency Medicine Nurse Practitioner and Physician Assistant Burnout, Perceived Stress, and Utilization of Wellness Resources During 2020 in a Large Urban Medical Center
Authors: Seitz Roslyn , Robertson Jennifer , Moran Timothy P. , Zdradzinski Michael J. , Kaltiso Sheri-Ann O. , Heron Sheryl , Lall Michelle D.
Published: January 2022

The objectives of this study were to measure perceived stress, burnout, and utilization and perceived benefit of wellness practices among emergency medicine (EM) nurse practitioners (NPs) and physician assistants (PAs). An additional aim was to evaluate attributions of stress to racism and the COVID-19 pandemic. A 28-item electronic survey of ED NPs/PAs at 3 hospitals was used to measure respondents' perceived stress (Perceived Stress Scale), stress attributed to COVID-19 and systemic racism, burnout (2-item measure), and utilization and helpfulness of wellness practices. The sample consisted of 53 ED NPs/PAs respondents (response rate 42.4%). More than one half (58.5%) reported burnout from their job, and a majority (58.5%) reported moderate to high stress. Burnout was reported by 70% of female respondents compared with 30.8% of male respondent (p = 0.002). A large majority (70%) of Black respondents reported concerns about experiencing racism at work, and 58.8% reported higher levels of stress attributed to racism. Respondents reported meals during shifts, community donated personal protective equipment, flexible work hours, and societal offerings of financial support (e.g., Internal Revenue Service stimulus check) as helpful. The COVID-19 pandemic and the impact of systemic racism are significant contributors to the stress and burnout of NPs/PAs. Female ED NPs/PAs disproportionally share the burden of burnout. Strategies to reduce burnout should be prioritized by institutional leadership. In addition, a majority of Black ED NPs/PAs are concerned about experiencing racism at work and report moderate to high stress associated with racism in general. There is an urgent need to address racism in the workplace with training on implicit bias, systemic racism, and allyship behavior.
FAMILY LIFE EXPERIENCES IN CARING FOR CHILDREN WITH LEUKEMIA: A LITERATURE REVIEW
Authors: Nurjanah Siti , Septianingrum Yurike , Pandin Moses Glorino Rumambo
Published: January 2022

Acute Lymphoblastic Leukemia (ALL) is the most common childhood cancer, and ALL is the leading cause of death in children. Chronic diseases, one of which is cancer suffered by children, can provide varied responses to families. Caring for children with cancer requires a very long and complex process, so it requires good coordination between children, parents, families and the health team. The purpose of this literature review is to obtain in-depth information on the experiences of parents in caring for children with cancer. The method of writing this article is a literature review of 40 articles with the year 2019-2021 published from electronic database, namely CINAHL, Web of Science, SAGE and Proquest. The method of searching and selecting articles used The Center for Review and Dissemination and the Joanna Briggs Institute Guideline and PRISMA diagram. Checklist with selection criteria using the PICOS approach. The results of a literature review show that while caring for children with cancer, parents experience stress, anxiety about losing a child, uncertainty in child treatment, difficulties in caring for children and family responsibilities. Support in the form of psychosocial, material, and social support is needed for parents. The declining health condition of children is the biggest obstacle for parents, material needs are needed to support the care of children suffering from cancer, and there is hope from parents for their child’s recovery.
Knowledge and aptitude of early childhood, primary and/or secondary education teachers referred to first aid measures in dental trauma in the province of Seville (Spain.)
Authors: Ribas Pérez David , Olivera Rosmery , Mendoza-Mendoza Asunción
Published: January 2022

The high of childhood dental trauma requires childcare professionals to have basic notions of dental first aid. Theaimof this study is to assess the level of knowledge and aptitude (defined as the ability to operate competently in a given activity) of early childhood, primary and/or secondary education teachers from Seville (Spain) referred to first aid measures in dental trauma. A descriptivestudywas made. The study sample consisted of 442 teachers (334 women and 108 men) coinciding proportionately with the study target population in terms of gender distribution, type of center and teaching level.

Methods

A specifically designed questionnaire was used.

Results

Most of the participants (88.5%, n=391) exhibited poor knowledge and aptitude, 11.5% (n=51) showed medium level knowledge and aptitude, and none were categorized as having high knowledge and aptitude.

Conclusion

These findings could be explained by the fact that 98% of those surveyed had never received any training in this area.
Immune response to third SARS-CoV-2 vaccination in seronegative kidney transplant recipients: possible improvement by mycophenolate mofetil reduction
Authors: Kantauskaite Marta , Müller Lisa , Hillebrandt Jonas , Lamberti Joshua , Fischer Svenja , Kolb Thilo , Ivens Katrin , Koch Michael , Andree Marcel , Lübke Nadine , Schmitz Michael , Luedde Tom , Orth Hans Martin , Feldt Torsten , Schaal Heiner , Adams Ortwin , Schmidt Claudia , Kittel Margarethe , Königshausen Eva , Rump Lars C. , Timm Jörg , Stegbauer Johannes
Published: January 2022

Background

Modification of vaccination strategies is needed to improve the immune response to SARS-CoV-2 vaccination in kidney transplant recipients (KTRs).

Methods

This multicenter observational study aimed to determine antibody kinetics among 60 seropositive KTRs and analyzed the effects of the third vaccination against SARS-CoV-2 in 174 previously seronegative KTRs. We investigated whether mycophenolate mofetil (MMF) dose reduction by 25-50% prior the third vaccination influences vaccination success.

Results

18 of 60 (30%) seropositive KTRs became seronegative in the serological assay within six months. Loss of antibodies was predicted by low initial antibody levels (≤206.8 BAU/ml), older age, and impaired graft function. A third vaccination in previously seronegative KTRs induced seroconversion in 56 of 174 (32.1%) KTRs with median antibody levels 119 (76–353) BAU/ml and median neutralizing capacity titer of 1:10 (0– 1:40). Multivariate logistic regression revealed that initial antibody levels (OR 1.39, 95% CI 1.09–1.76), graft function (OR 0.05, 95% CI 0.01–0.39), time after transplantation (OR 1.04, 95% CI 1.02–1.07) and MMF trough levels (OR 0.43, 95% CI 0.21–0.88) correlated with seroconversion, p<0.05. After controlling for these confounders, the effect of MMF dose reduction was calculated using propensity score matching. KTRs in the MMF reduction group had significantly lower MMF serum concentrations prior to the third vaccination and were more likely to develop antibody levels ≥35.2 BAU/ml than their matched KTRs (p=0.02).

Conclusions

Temporary reduction in MMF dose might be a promising approach to improve the immune response in KTRs.
Cohort Profile: The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH)
Authors: Bryant Luke , Free Robert C , Woolf Katherine , Melbourne Carl , Guyatt Anna L , John Catherine , Gupta Amit , Gray Laura J , Nellums Laura , Martin Christopher A , McManus I Chris , Garwood Claire , Modhawdia Vishant , Carr Sue , Wain Louise V , Tobin Martin D , Khunti Kamlesh , Akubakar Ibrahim , Pareek Manish
Published: January 2022

Key Features of the UK-REACH Cohort (Profile in a nutshell)

The UK-REACH Cohort was established to understand why ethnic minority healthcare workers (HCWs) are at risk of poorer outcomes from COVID-19 when compared to their white ethnic counterparts in the United Kingdom (UK). Through study design, it contains a uniquely high percentage of participants from ethnic minority backgrounds about whom a wide range of qualitative and quantitative data has been collected.

A total of 17891 HCWs aged 16-89 years (mean age: 44) have been recruited from across the UK via all major healthcare regulators, individual National Health Service (NHS) hospital trusts and UK HCW membership bodies who advertised the study to their registrants/staff to encourage participation in the study.

Data available include linked healthcare records for 25 years from the date of consent and consent to obtain genomic sequencing data collected via saliva. Online questionnaires include information on demographics, COVID-19 exposures at work and home, redeployment in the workforce due to COVID-19, mental health measures, workforce attrition, and opinions on COVID-19 vaccines, with baseline (n=15 119), 6 (n=5632) and 12-month follow-up data captured.

Request data access and collaborations by following documentation found at https://www.uk-reach.org/main/data_sharing.
Single-Cell RNA Sequencing Reveals the Altered Landscape of Immune Cells in Immune Checkpoint Inhibitor Related Myocarditis
Authors: Lou Bowen , Guo Manyun , Chen Fangyuan , Wang Chen , Tuerhongjiang Gulinigaer , Zheng Tao , Zhou Bo , Yuan Zuyi , She Jianqing
Published: January 2022

Background

Myocarditis has emerged as a rare but lethal Immune checkpoint inhibitor (ICI)-associated toxicity. However, the exact mechanism for ICI related myocarditis remains underexplored; and the specific therapeutic targets is still lacking. In this study, we used scRNA-seq to characterize the transcriptomic profiles of single cells from the peripheral blood mononuclear cell (PBMC) of ICI related myocarditis during fulminant myocarditis and disease recovery.

Methods

PBMC samples were taken from the patient during fulminant ICI related myocarditis and after disease remission. Cells were isolated from blood samples by density gradient centrifugation over Ficoll-Paque. Single-cell RNA sequencing with 10X genomics was performed. Subpopulation determination, functional analysis, single-cell trajectory and cell-cell interaction analysis were carried out afterwards.

Results

We presented the altered landscape of immune cells and differential genes in ICI related myocarditis during the disease activity and remission using scRNA-seq. Substantial immune cell composition and intercellular communication were found to be altered. Monocyte, NK cell as well as B cell subpopulations contributed to the regulation of innate immunity and inflammation in ICI related myocarditis. T cell subpopulations highly expressed genes associated with PD-1 inhibitor resistance and hyper-progressor. At last, the intercellular communication in ICI related myocarditis was significantly dysregulated.

Conclusion

By identifying altered pathways and highlighting a catalog of marker genes, this study has revealed the diversity of cellular populations in ICI related myocarditis, marked by their distinct transcriptional profiles and biological functions. Our investigation would shed light on the pathophysiological mechanism and potential therapeutic targets of ICI related myocarditis in continuous exploration.
Nucleocapsid antigenemia is a marker of acute SARS-CoV-2 infection
Authors: Verkerke Hans P. , Damhorst Gregory L. , Graciaa Daniel S. , McLendon Kaleb , O’Sick William , Robichaux Chad , Cheedarla Narayanaiah , Potlapalli Sindhu , Wu Shang-Chuen , Harrington Kristin R.V. , Webster Andrew , Kraft Colleen , Rostad Christina A. , Waggoner Jesse J. , Gandhi Neel R. , Guarner Jeannette , Auld Sara C. , Neish Andrew , Roback John D. , Lam Wilbur A. , Shah N. Sarita , Stowell Sean R.
Published: January 2022

Background

Reliable detection of SARS-CoV-2 infection is essential for diagnosis and treatment of disease as well as infection control and prevention during the ongoing COVID-19 pandemic. Existing nucleic acid tests do not reliably distinguish acute from resolved infection, as residual RNA is frequently detected in the absence of replication-competent virus. We hypothesized that viral nucleocapsid in serum or plasma may be a specific biomarker of acute infection that could enhance isolation and treatment strategies at an individualized level.

Methods

Samples were obtained from a retrospective serological survey using a convenience sampling method from adult inpatient and outpatient encounters from January through March 2021. Samples were categorized along a timeline of infection (e.g. acute, late presenting, convalescent) based on timing of available SARS-CoV-2 testing and symptomatology. Nucleocapsid was quantified by digital immunoassay on the Quanterix HD-X platform.

Results

In a large sample of 1860 specimens from 1607 patients, the highest level and frequency of antigenemia were observed in samples obtained during acute SARS-CoV-2 infection. Levels of antigenemia were highest in samples from seronegative individuals and in those with more severe disease. Using ROC analysis, we found that antigenemia exhibited up to 85.8% sensitivity and 98.6% specificity as a biomarker for acute COVID-19.

Conclusions

Nucleocapsid antigenemia is a sensitive and specific biomarker for acute SARS-CoV-2 infection and may aid in individualized assessment of SARS-CoV-2 infection resolution or persistence, although interpretation is limited by absence of a diagnostic gold standard for active infection.
Appropriate management of steroids and discharge planning during and after hospital admission for moderate-severe ulcerative colitis
Authors: Dulai Parambir S. , Rai Victoria , Raffals Laura E. , Lukin Dana , Hudesman David , Kochhar Gursimran S. , Damas Oriana M. , Sauk Jenny S. , Levy Alexander N. , Sofia M. Anthony , Tuskey Anne , Deepak Parakkal , Yarur Andres J. , Afzali Anita , Ananthakrishnan Ashwin N , Cross Raymond K. , Hanauer Stephen B. , Siegel Corey A.
Published: January 2022

Background

Limited guidance exists for the post-discharge care of ulcerative colitis (UC) patients hospitalized for moderate-severe flares.

Methods

RAND methodology was used to establish appropriateness of inpatient and post-discharge steroid dosing, discharge criteria, follow-up, and post-discharge biologic or small molecule initiation. A literature review informed the panels voting, which occurred anonymously during two rounds before and after a moderated virtual session.

Results

Methylprednisolone 40-60mg IV every 24 hours or hydrocortisone 300mg IV three times daily are appropriate for inpatient management, with methylprednisolone 40mg being appropriate if intolerant of higher doses. It is appropriate to discharge patients once rectal bleeding has resolved (Mayo sub score 0-1) and/or stool frequency has returned to baseline frequency and form (Mayo sub score 0-1). It is appropriate to discharge patients on 40mg of prednisone after observing patients for 24 hours in-hospital to ensure stability prior to discharge. For patients being discharged on steroids without in-hospital biologic or small molecule therapy initiation, it is appropriate to start anti-TNF therapy after discharge for anti-TNF naïve patients. For anti-TNF exposed patients it is appropriate to start vedolizumab or ustekinumab for all patients, and tofacitinib for those with a low risk of adverse events. It is appropriate to follow up patients clinically within 2 weeks, and with lower endoscopy within 4-6 months after discharge.

Conclusion

We provide guidance on the inpatient and post-discharge management of UC patients hospitalized for moderate-severe flares.

STUDY HIGHLIGHTS

WHAT IS KNOWN

Ulcerative colitis patients hospitalized for disease flares are a high-risk population

Guidance on evaluation and initial management during flares is provided, however, limited guidance exists on standardization of steroid management and post-discharge care

WHAT IS NEW HERE

Through a RAND Appropriateness Panel we provide guidance on the inpatient and post-discharge management of steroids, discharge criteria, post-discharge monitoring and management of biologics or small molecule therapies

These recommendations will help to bring uniformity to care for this high-risk population, and optimize outcomes in clinical practice
Spectral clustering of single-cell multi-omics data on multilayer graphs
Authors: Zhang Shuyi , Leistico Jacob R. , Cho Raymond J. , Cheng Jeffrey B. , Song Jun S.
Published: January 2022

Single-cell sequencing technologies that simultaneously generate multimodal cellular profiles present opportunities for improved understanding of cell heterogeneity in tissues. How the multimodal information can be integrated to obtain a common cell type identification, however, poses a computational challenge. Multilayer graphs provide a natural representation of multi-omic single-cell sequencing datasets, and finding cell clusters may be understood as a multilayer graph partition problem.

We introduce two spectral algorithms on multilayer graphs, spectral clustering on multilayer graphs (SCML) and the weighted locally linear (WLL) method, to cluster cells in multi-omic single-cell sequencing datasets. We connect these algorithms through a unifying mathematical framework that represents each layer using a Hamiltonian operator and a mixture of its eigenstates to integrate the multiple graph layers, demonstrating in the process that the WLL method is a rigorous multilayer spectral graph theoretic reformulation of the popular Seurat weighted nearest neighbor (WNN) algorithm. Implementing our algorithms and applying them to a CITE-seq dataset of cord blood mononuclear cells yields results similar to the Seurat WNN analysis. Our work thus extends spectral methods to multimodal single-cell data analysis.

The code used in this study can be found at https://github.com/jssong-lab/sc-spectrum
Exploring human mixing patterns based on time use and social contact data and their implications for infectious disease transmission models
Authors: Hoang Thang Van , Willem Lander , Coletti Pietro , Kerckhove Kim Van , Minnen Joeri , Beutels Philippe , Hens Niel
Published: January 2022

Background

The increasing availability of data on social contact patterns and time use provides invaluable information for studying transmission dynamics of infectious diseases. Social contact data provide information on the interaction of people in a population whereas the value of time use data lies in the quantification of exposure patterns. Both have been used as proxies for transmission risks within in a population and the combination of both sources has led to investigate which kind of social encounters are most relevant to describe transmission risk.

Methods

We used social contact and time use data from 1707 participants from a survey conducted in Flanders, Belgium in 2010-2011. We calculated weighted exposure time and social contact matrices to analyze age- and gender-specific mixing patterns and to quantify behavioral changes by distance from home. We compared the value of both data sources, individually and combined, for explaining seroprevalence and incidence data on parvovirus-B19, Varicella-Zoster virus (VZV) and influenza-like illnesses (ILI), respectively.

Results

Assortative mixing and inter-generational interaction is more pronounced in the exposure matrix due to the high proportion of time spent at home. This pattern is less pronounced in the social contact matrix, which is more impacted by the reported contacts at school and work. The average number of contacts declined with distance, however on the individual-level, we observed an increase in the number of contacts and the transmission potential by distance when travelling.

We found that both social contact data and time use data provide a good match with the seroprevalence and incidence data at hand. When comparing the use of different combinations of both data sources, we found that the social contact matrix based on close contacts of at least 4 hours appeared to be the best proxy for parvovirus-B19 transmission. Social contacts and exposure time were both on their own able to explain VZV seroprevalence data though combining both scored best. Compared with the contact approach, the time use approach provided the better fit to the ILI incidence data.

Conclusions

Our work emphasises the common and complementary value of time use and social contact data for analysing mixing behavior and infectious disease transmission. We derived spatial, temporal, age-, gender- and distance-specific mixing patterns, which are informative for future modelling studies.
Long term effectiveness of inactivated vaccine BBIBP-CorV (Vero Cells) against COVID-19 associated severe and critical hospitalization in Morocco
Authors: Belayachi Jihane , Obtel Majdouline , Razine Rachid , Abouqal Redouane
Published: January 2022

INTRODUCTION

We provide national estimates of the real-world Vaccine effectiveness (VE) based on nationally available surveillance data. The study aimed to estimate the effectiveness of the inactivated Covid-19 vaccine BBIBP-CorV (Vero Cells) Sinopharm vaccine currently deployed in Morocco to reduce the risk of hospitalization from a severe infection of SARS- CoV-2 virus within 9 months after vaccination.

METHODS

We conducted a test-negative, case-control study among a population aged 18 years or older who were tested by rt-PCR for SARS-CoV-2 infection from February to October 2021 in Morocco. From the national laboratory COVID-19 database; we identified cases who were rt-PCR positive amongst severe and critical COVID-19 cases and controls who had a negative rt-PCR test for SARS-CoV-2. From the national vaccination register (NVR); individuals vaccinated with COVID-19 Vaccine (Vero Cell) and those unvaccinated were identified and included in the study. The linkage between databases was conducted for the study of Vaccination status based on the timing of the vaccine receipt relative to the SARS-CoV-2 rt-PCR test date. For each person, who tested positive for SARS-CoV-2, we identified a propensity score-matched control participant who was tested negative. We estimated vaccine effectiveness using conditional logistic regression.

RESULTS

Among 12884 persons who tested positive and 12885 propensity score-matched control participants, the median age was 62 years, 47.2% of whom were female. As a function of time after vaccination of second dose vaccination, vaccine effectiveness during the first month was 88% (95% CI, 84-91), 87% (95% CI: 83-90) during the second and third month, 75% (95% CI: 67-80) during the fourth month, 61% (95% CI: 54-67) during the fifth month, and 64% (95% CI: 59-69) beyond the sixth month. VE remained high and stable during the first three months in the two-age subgroup. In the fourth month, the VE in the older population aged 60 years and above (64%) was reduced by 20 points compared to VE in the younger population (84%).

CONCLUSION

A Sinopharm vaccine is highly protective against serious SARS-CoV-2 infection under real-world conditions. Protection remained high and stable during the first three months following the second dose and decreases slightly beyond the fourth month especially beyond 60 years.
Utility of 3D printing in the surgical management of intra-articular distal humerus fractures: A protocol for Systematic Review and Meta-analysis
Authors: Baburaj Vishnu , Patel Sandeep , Kumar Vishal , Dhillon Mandeep Singh
Published: January 2022

Background

The quality of reduction in distal humerus fractures plays a crucial role in obtaining good postoperative functional outcomes. The use of 3D printed models for preoperative planning could help improve reduction and hence potentially influencing outcomes after surgery.

Objectives

This systematic review aims to compare the outcome of surgeries done with the help of 3D printing assistance to those done with conventional techniques in distal humerus intraarticular fractures.

Methods

A systematic review will be conducted according to the PRISMA guidelines. Electronic databases of PubMed, Embase, Scopus and Ovid will be searched with a pre-defined search strategy. Bibliography of included articles will also be searched for more potential studies. Original research articles published since inception till the date of search in English language that compare the outcomes of 3D print-assisted surgery with those done without the help of 3D printing will be included. Review articles, conference abstracts and animal studies will be excluded. Outcome measures will be extracted from the selected studies and analysed with the help of appropriate software.
Effectiveness of a SARS-CoV-2 mRNA vaccine booster dose for prevention of infection, hospitalization or death in two nation-wide nursing home systems
Authors: McConeghy Kevin W. , Bardenheier Barbara , Huang Andrew W. , White Elizabeth M. , Feifer Richard A. , Blackman Carolyn , Santostefano Christopher M. , Lee Yoojin , DeVone Frank , Halladay Christopher W. , Rudolph James L. , Zullo Andrew R. , Mor Vincent , Gravenstein Stefan
Published: January 2022

Background

A SARS-CoV-2 vaccine booster dose has been recommended for all nursing home residents. However, we lack effectiveness data on boosters preventing infection, death and hospitalization in this frail population.

Methods

We emulated nested target trials in two large nursing home systems in parallel to evaluate the effectiveness of a SARS-CoV-2 mRNA vaccine booster at preventing infection, hospitalization, or death. Residents who completed a 2-dose series of the mRNA vaccine and were eligible for a booster were included in from September 22, 2021 to November 5, 2021. Outcomes were measured through December 18, 2021, including test-confirmed SARS-CoV-2 infection, hospitalization, or death. The vaccine effectiveness at day 42 was estimated with a Kaplan-Meier estimator, both unadjusted and weighted with the inverse probability of treatment.

Results

The two NH systems were large and multi-state, System 1 included 200 NH (8,538 control and 5,721 boosted residents) and System 2 included 127 NHs (4,100 control and 2,291 boosted residents). Booster vaccination reduced infections by 50.4% (95% Confidence Interval [CI]: 29.4%, 64.7%) SARS-CoV-2 infections in System 1 and 58.2% (32.3%, 77.8%) in System 2. Boosted residents in System 1 also had a 97.3% (86.9%, 100.0%) reduction in SARS-CoV-2 associated death, but too few events for comparison in System 2.

Conclusions

During a Delta predominant period, SARS-CoV-2 booster vaccination significantly reduced infection in two U.S. nursing home systems. In the larger System 1 a 97% reduction in SARS-CoV-2 related death was also observed. These findings strongly support administration of vaccine boosters to nursing home residents.