bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-sided femoral Campylobacter jejuni osteomyelitis in a patient with acquired hypogammaglobulinemia: a case report
Authors: Hartman Joost , Westerman Matthijs , Wagenaar Jiri F. P.
Published: March 2020

Background

Campylobacter jejuni is a motile, gram-negative rod known for causing self-limiting enterocolitis while rarely causing extraintestinal infections. We report the first case of a patient with Campylobacter jejuni osteomyelitis in both femora.

Case presentation

A 54-year-old female presented with progressive pain in both upper extremities. Her past medical history mentioned a lymphoplasmacytic lymphoma (LPL) for which she had received dexamethasone, cyclophosphamide and fludarabine and was still receiving maintenance therapy with intravenous rituximab. Two months prior to presentation, she received oral fluoroquinolone for a recurrent enterocolitis with stool cultures positive for Campylobacter jejuni. Palpation of the left quadriceps femoris muscle was remarkably painful during physical examination. Laboratory testing showed elevated C-reactive protein and recent low gamma globulin levels. The presumptive diagnosis at this point was a transformation of LPL to a large B cell lymphoma. In order to determine the preferred site for biopsy, a fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography was done. However, blood cultures taken on admission showed growth of Campylobacter jejuni in both aerobic bottles, with a strain resistant to fluoroquinolones. Diagnosis of Campylobacter jejuni osteomyelitis was confirmed with 16S ribosomal RNA gene polymerase chain reaction performed on femoral bone obtained through biopsy. Treatment with intravenous imipenem/cilastatin followed by intravenous and oral doxycycline proved insufficient. Subsequently, the patient was treated successfully with intravenous meropenem for six weeks and concurrent intravenous immunoglobulin.

Conclusion

We report the first case of Campylobacter jejuni osteomyelitis in both femora in a patient with acquired hypogammaglobulinemia. Diagnosis was confirmed by blood cultures and positive 16S ribosomal RNA gene polymerase chain reaction for Campylobacter spp. on bone biopsy. Treatment was successful with intravenous meropenem and immunoglobulin. Our report showcases an unusual manifestation in a patient with immunodeficiency and discusses failure of initial antibiotic therapy.
Prevalence of viral sexually transmitted infections and HPV high-risk genotypes in women in rural communities in the Department of La Paz, Bolivia
Authors: Patzi-Churqui Marianela , Terrazas-Aranda Katty , Liljeqvist Jan-Åke , Lindh Magnus , Eriksson Kristina
Published: March 2020

Background

Bolivia has the highest prevalence of cervical cancer in South America and the prevalence of viral sexually transmitted infections (STIs) among people in urban cities is increasing. Little is known about the prevalence of viral STIs in rural communities, which generally have limited access to health care. In order to study the prevalence of viral STIs in rural Bolivia, we recruited women from villages and towns in the Department of La Paz in Bolivia.

Methods

Three hundred ninety-four female participants were assessed for IgG-antibodies to herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and hepatitis B virus (HBV, anti-HBc), as well as for the presence of HBV surface antigen (HBsAg) in dried blood spots. The prevalence of 12 high-risk types of human papillomavirus (HPV) was assessed by qPCR in dried cervicovaginal cell spots from 376 of these women. χ2 test was used to compare variables between the populations and binary logistic regression was used to identify risk factors associated with the positivity of the tests.

Results

The seroprevalence of HSV-2 was 53% and of HBV 10.3%. HBAg was detected in 15.8% of women with anti-HBV antibodies indicating chronic infection. The frequency of high-risk HPV infection was 27%, with the most prevalent high-risk HPV types being HPV 56, 39 and 31 followed by HPV 16 and 18. Finally, none of the 394 women were seropositive for HIV, and about 64% of the studied population was positive for at least one of the viral infections.

Conclusions

Women in Bolivian rural communities in La Paz show a high prevalence of HBV, HPV and, in particular, HSV-2. In contrast, none of the women were HIV positive, suggesting that the HIV prevalence in this population is low. The pattern of high-risk HPV types differed from many other countries with a predominance of HPV-types not included in the Gardasil vaccine which was officially introduced in Bolivia in April 2017.
Rabies in Uganda: rabies knowledge, attitude and practice and molecular characterization of circulating virus strains
Authors: Omodo Michael , Ar Gouilh Meriadeg , Mwiine Frank Norbert , Okurut Anna Rose Ademun , Nantima Noelina , Namatovu Alice , Nakanjako Maria Flavia , Isingoma Emmanuel , Arinaitwe Eugene , Esau Martin , Kyazze Simon , Bahati Milton , Mayanja Franklin , Bagonza Patrick , Urri Richard Akule , Lovincer Mary Nanfuka , Nabatta Esther , Kidega Eugene , Ayebazibwe Chrisostom , Nakanjako Gladys , Sserugga Joseph , Ndumu Deo Birungi , Mwebe Robert , Mugabi Kenneth , Gonzalez Jean-Paul , Sekamatte Musa
Published: March 2020

Background

Rabies is a deadly preventable viral disease that affects all warm-blooded animals and widespread in many regions including Africa. The disease remains of major public health importance in Uganda.

The purpose of this study was to establish Knowledge, Attitude, Practice (KAP) of Rabies in Moyo and Ntoroko districts and to characterize Rabies virus (RABV) strains from seven districts of Uganda with consistent prevalence of rabies.

Methods

KAP survey data were collected based on animal biting history by interviewing the head of the veterinary departments, the medical centers and selected households from the study sites. Data were obtained from 84 households in Ntoroko and Moyo districts. Thirty-five (35) brain samples were collected from bovine, dogs, goats, foxes, jackals ad sheep between 2011 and 2013. Samples were tested using fluorescent antibody test (FAT), One step RT-PCR (following RNA extraction) and partial RABV N gene was sequenced by Sanger method before phylogenetic and phylogeographic analyses of sequences.

Results

Scarcity of post-exposure prophylaxis services in the health centers was noted. Poor attitude of wound washing and deficiency of knowledge on how to handle wounds related to dog bites and the significance among household participants lacked. There is a high risk of rabies infection due to a limited dog’s vaccination. Dog biting episodes in humans were of 75.00 and 62.50% in Moyo and Ntoroko districts respectively. Twenty-seven (27) samples tested positive for rabies by FAT and PCR. Ugandan sequences were closely related (97% nucleotide id) to the rabies virus sequences from Tanzania, Rwanda, Burundi, Nigeria, Central African Republic and Sudan with both the “Africa 1A” and “Africa 1B” RABV clades represented. A putative new clade 1D was also detected.

Conclusions

Rabies remains a public health hazard in Uganda. There is urgent need to establish advocacy programs in both schools and communities to curtail the spread of rabies. Increasing the knowledge regarding wound washing, post-exposure prophylaxis and dogs vaccination would enhance prevention of rabies. A strong collaboration between medical and veterinary sectors under a one health platform is required to ensure sufficient preventative services to the communities.
Epidemiology and clinical characteristics of pathogens positive in hospitalized children with segmental/lobar pattern pneumonia
Authors: Wang Yanxia , Ma Liji , Li Ying , Li Yuyun , Zheng Yanfei , Zhang Xiaoyue
Published: March 2020

Background

The occurrence of segmental/lobar pattern pneumonia (S/L-PP) in children has recently increased. The pathogens of the disease may change for the misuse of antibiotics and the application of vaccines. Therefore, pathogens positive in hospitalized children with S/L-PP and their association with clinical characteristics may have changed. The aim of this study was to analyze the pathogens positive in hospitalized children with S/L-PP and their association with clinical characteristics.

Method

The current study analyzed the epidemiological and clinical characteristics of pathogens positive in children with S/L-PP under 14 years old at a single hospital between 1st Jan 2014 and 31st Dec 2018 retrospectively. The pathogens were detected by microbial cultivation, indirect immunofluorescence of the kit (PNEUMOSLIDE IgM), Elisa, and/or real-time PCR in the samples of the patients.

Results

A total of 593 children with S/L-PP received treatment at a single hospital during the study period by inclusion criteria. Four hundred fifty-one patients were single positive for one pathogen and 83 patients were positive for at least 2 pathogens. Mycoplasma pneumoniae (M.pneumoniae) (72.34%) was the most commonly detected pathogen, followed by Streptococcus pneumoniae (S.pneumoniae) (8.77%). The prevalence of M.pneumoniae in children with S/L-PP increased with time (p < 0.05). The positive rate of M.pneumoniae increased with ages of patients (p < 0.05). M.pneumoniae was statistically associated with the extrapulmonary manifestations while S.pneumoniae was statistically associated with abnormal white blood cells (WBCs) and C reactive proteins (CRPs) (p < 0.05).

Conclusion

M.pneumoniae was the most positive pathogen in children with S/L-PP. The positive rate of M.pneumoniae in children with S/L-PP increased with time and the ages of children. M.pneumoniae was associated with extrapulmonary manifestations while S.pneumoniae was associated with abnormal WBCs and CRPs.
Factors determining recurrence in transient global amnesia
Authors: Tynas Rebecca , Panegyres Peter K.
Published: March 2020

Background

Aetiology of transient global amnesia (TGA) remains uncertain, though many have been proposed, including ischaemic, migrainous or epileptic pathologies.

Methods

We attempted to determine risk factors for TGA, as well as prognostic factors that may cause recurrence. We evaluated clinical history, family history and magnetic resonance diffusion-weighted imaging (DWI) studies of 93 prospective patients with TGA. Patients were followed from 2004 to 2016. Fifteen of 93 (16%) patients experienced a recurrence of TGA.

Results

Among precipitating events, physical activities inducing Valsalva-like manoeuvres were most common, followed by emotional stress. Eighty-four patients had possible comorbidities or risk factors for TGA, though no single risk factor was ubiquitous. Risk factors associated with recurrence were head injury (isolated vs. recurrent, 16.7% vs. 53.5%, p < 0.01), depression (isolated vs. recurrent, 15.4% vs 46.7%, p = 0.01) and family history of dementia (isolated vs. recurrent, 20.5% vs. 46.7%, p = 0.03). Of 15 patients with confirmed recurrent TGA, two developed dementia and four subjective memory impairment. DWI lesions were observed in 24 patients and were located anywhere within the hippocampus.

Conclusions

DWI lesions were not significantly associated with outcomes (recurrence, subjective memory impairment, dementia). We have found that depression, previous head injury and family history of dementia may predict TGA recurrence.
Status of family planning integration to HIV care in Amhara regional state, Ethiopia
Authors: Zewdie Zebideru , Yitayal Mezgebu , Kebede Yigzaw , Gebeyehu Abebaw
Published: March 2020

Background

Preventing unintended pregnancies among HIV positive women is one component of HIV prevention strategies. However, programs to prevent mother-to-child transmission (PMTCT) of HIV started in antenatal care. The objective of this study was to examine the status of family planning integration to HIV care from client and facility perspectives and identify factors associated with current family planning use.

Methods

A facility-based cross-sectional study was conducted from December 2017 to April 2018. Data were coded and double entered into EPI Info version 3.5.4 and exported to STATA version 14 for analysis. Bi-variable and multivariable logistic regression analyses were conducted to assess the association of variables with the current family planning use.

Results

A total of 518 HIV-positive women were included in the study. Among HIV-positive women, 35.3% had an unmet need for family planning, and 21.4% responded that their pregnancies were unwanted. About two-thirds (68.1%) of women were using a modern family planning method at the time of the study. Among women who were currently using family planning, 88.8% got the service from a family planning clinic in the same facility, and only 1.1% got the service from the HIV care unit. Women who were not knowledgeable on PMTCT (AOR 0.47, 95% CI = 0.24–0.90), divorced or separated women (AOR 0.19, 95% CI = 0.10–0.37) and women in the age group of 25–34 years (AOR 0.42, 95% CI = 0.20–0.88) and 35–49 years (AOR 0.41, 95% CI = 0.17–0.99) were less likely to use modern family planning methods compared with those women who were knowledgeable, married and women in the age group of 15–24 years. Besides, women with higher income (AOR 2.12, 95% CI = 1.26–3.57) were more likely to use modern family planning methods compared with women with lower incomes.

Conclusion

This study indicated that there is a high unmet need for family planning among HIV-positive women and low family planning services integration in the PMTCT/ART clinics. Efforts should be strengthened to tackle the factors which hinder the use of modern family planning and improve family planning service integration.
Necessity of prophylactic splenic hilum lymph node clearance for middle and upper third gastric cancer: a network meta-analysis
Authors: Zheng Gaozan , Liu Jinqiang , Guo Yinghao , Wang Fei , Liu Shushang , Xu Guanghui , Guo Man , Lian Xiao , Zhang Hongwei , Feng Fan
Published: March 2020

Background

It remains controversial whether prophylactic No.10 lymph node clearance is necessary for gastric cancer. Thus, the present study aims to investigate the impact of prophylactic No.10 lymph node clearance on the perioperative complications and prognosis of upper and middle third gastric cancer.

Methods

A network meta-analysis to identify both direct and indirect evidence with respect to the comparison of gastrectomy alone (G-A), gastrectomy combination with splenectomy (G + S) and gastrectomy combination with spleen-preserving splenic hilar dissection (G + SPSHD) was conducted. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies published before September 2018. Perioperative complications and overall survival were analyzed. Hazard ratios (HR) were extracted from the publications on the basis of reported values or were extracted from survival curves by established methods.

Results

Ten retrospective studies involving 2565 patients were included. In the direct comparison analyses, G-A showed comparable 5-year overall survival rate (HR: 1.1, 95%CI: 0.97–1.3) but lower total complication rate (OR: 0.37, 95%CI: 0.17–0.77) compared with G + S. Similarly, the 5-year overall survival rate between G + SPSHD and G + S was comparable (HR: 1.1, 95%CI: 0.92–1.4), while the total complication rate of G + SPSHD was lower than that of G + S (OR: 0.50, 95%CI: 0.28–0.88). In the indirect comparison analyses, both the 5-year overall survival rate (HR: 1.0, 95%CI: 0.78–1.3) and total complication rate (OR: 0.75, 95%CI: 0.29–1.9) were comparable between G-A and G + SPSHD.

Conclusions

Prophylactic No.10 lymph node clearance was not recommended for treatment of upper and middle third gastric cancer.
Utility of magnetic resonance imaging in determining treatment response and local recurrence in nasopharyngeal carcinoma treated curatively
Authors: Meng Katherine , Tey Jeremy , Ho Francis Cho Hao , Asim Hira , Cheo Timothy
Published: March 2020

Background

To determine the optimal timing of the first Magnetic Resonance Imaging (MRI) scan after curative-intent radiotherapy (RT) for nasopharyngeal carcinoma (NPC), and evaluate the role of MRI in surveillance for locoregional recurrence (LRR).

Methods

Patients with non-metastatic NPC treated radically who had at least one post-treatment MRI (ptMRI) done were included for analysis. ptMRI reports were retrospectively reviewed and categorised as complete response (CR), partial response/residual disease (PR) or indeterminate (ID). Patients with LRR were assessed to determine if initial detection was by MRI or clinical means. Univariable and multivariable Cox proportional hazard regression analysis were performed to identify independent factors associated with CR on ptMRIs.

Results

Between 2013 and 2017, 262 eligible patients were analysed, all treated with Intensity Modulated Radiotherapy (IMRT). Median time from end of RT to the first ptMRI was 93 days (range 32–346). Of the first ptMRIs, 88 (33.2%) were CR, 133 (50.2%) ID, and 44 (16.6%) PR. A second ptMRI was done for 104 (78.2%) of 133 patients with ID status. In this group, 77 (57.9%) of the subsequent MRI were determined to be CR, 21(15.8%) remained ID and 6 (4.5%) PR. T1 tumour stage and AJCC stage I were associated with increased CR rates on first ptMRI on multivariable analysis. ID status was more likely at 75–105 days (3 months +/− 15 days) vs 106–135 days (4 months +/− 15 days) post RT (OR 2.13, 95% CI 1.16–4.12, p = 0.024). LRR developed in 27 (10.1%) patients; 20 (74.1%) were initially detected through MRI, 3 (11.1%) by nasoendoscopy and 2 (7.4%) by PET-CT.

Conclusion

MRI is useful for detecting local recurrence or persistent disease after curative-intent treatment. Most patients will need more than one ptMRI to arrive at a definitive status. The rate of ID ptMRI may be reduced by delaying the first scan to around 4 months post RT.
Incidence and time trends of sarcoma (2000–2013): results from the French network of cancer registries (FRANCIM)
Authors: Amadeo Brice , Penel Nicolas , Coindre Jean-Michel , Ray-Coquard Isabelle , Ligier Karine , Delafosse Patricia , Bouvier Anne-Marie , Plouvier Sandrine , Gallet Justine , Lacourt Aude , Coureau Gaëlle , Monnereau Alain , Mathoulin-Pélissier Simone , Desandes Emmanuel
Published: March 2020

Background

The exhaustive collection of new sarcoma cases and their second histologic review offer a unique opportunity to study their incidence and time trends in France according to the major subtypes.

Methods

Data were collected from population-based cancer registries covering 22% of the French population. Crude and world age-standardized incidence rates (ASR) were estimated according to anatomic, histological and genetic groups, age and sex over the 2010–2013 period.

Results

Time trends in incidence were calculated by the annual percent change over the 2000–2013 period. During the most recent period (2010–2013), 3942 patients with sarcoma were included. The ASR of soft-tissue and bone sarcomas, and gastro-intestinal stromal tumors (GIST) were 2.1, 1.0 and 0.6, respectively. For the four most frequent histological subtypes (unclassified, leiomyosarcoma, GIST and liposarcoma), the ASR ranged from 0.4 to 0.7. ASRs were 1.9 for complex genomic and 1.3 for recurrent translocation sarcomas. The time-trend analysis showed a significant increase of sarcoma incidence rate between 2000 and 2005, which stabilized thereafter. Incidence rates increased for four histological subtypes (GIST, chondrosarcoma, myxofibrosarcoma, solitary fibrous tumors) and decreased for three (leiomyosarcomas, Kaposi sarcoma and fibrosarcoma).

Conclusion

To our knowledge, this study is the first to investigate sarcoma incidence based on a systematic pathological review of these cancers and on the updated sarcoma classifications. Due to the paucity of literature on sarcomas, future studies using data from population-based cancer registries should consider a standardized inclusion criterion presented in our study to better describe and compare data between countries.
QTc interval-dependent body posture in pediatrics
Authors: Reynisson Björn , Tanghöj Gustaf , Naumburg Estelle
Published: March 2020

Background

Syncope is a common and often benign disorder presenting at the pediatric emergency department. Long-QT syndrome may be presented with syncope, ventricular arrhythmias or sudden death and is vital to exclude as an underlying cause in children presented with syncope. Few studies have assessed QTc in relation to body posture in children. In this study, we assessed the QTc interval while laying down and during active standing in children with known long-QT syndrome compared to healthy controls.

Methods

Children aged 1–18 years with long-QT syndrome (N = 17) matched to two healthy controls (N = 34) were included in this case-control study. The ECG standing was performed immediately after the ECG in the supine position. The QTc interval and QTc-difference by changing the body position were calculated.

Results

All children with long-QT syndrome were treated with propranolol. QTc was prolonged among long-QT syndrome children while lying down and when standing up, compared to controls. A prolongation of QTc appeared when standing up for both cases and controls. There was no significant difference in QTc increase between the groups. A QTc over 440 ms was observed among four cases lying down and in eight cases while standing, but not in any of the controls. The standing test with a cut-off of 440 ms showed a sensitivity of 47% and a specificity of 100% for case-status in our study.

Conclusion

QTc measured on ECG when rapidly rising up is prolonged in both healthy and LQTS children. More importantly, it prolongs more in children with LQTS and increases in pathological levels.
A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities
Authors: Hosheh Osama , Edwards Christopher T. , Ramnarayan Padmanabhan
Published: March 2020

Background

Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research.

Methods

We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed.

Results

Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1–11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6–50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively).

Conclusion

This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.
Assessing physical activity in people with mental illness: 23-country reliability and validity of the simple physical activity questionnaire (SIMPAQ)
Authors: Rosenbaum S. , Morell R. , Abdel-Baki A. , Ahmadpanah M. , Anilkumar T. V. , Baie L. , Bauman A. , Bender S. , Boyan Han J. , Brand S. , Bratland-Sanda S. , Bueno-Antequera J. , Camaz Deslandes A. , Carneiro L. , Carraro A. , Castañeda C. P. , Castro Monteiro F. , Chapman J. , Chau J. Y. , Chen L. J. , Chvatalova B. , Chwastiak L. , Corretti G. , Dillon M. , Douglas C. , Egger S. T. , Gaughran F. , Gerber M. , Gobbi E. , Gould K. , Hatzinger M. , Holsboer-Trachsler E. , Hoodbhoy Z. , Imboden C. , Indu P. S. , Iqbal R. , Jesus-Moraleida F. R. , Kondo S. , Ku P. W. , Lederman O. , Lee E. H. M. , Malchow B. , Matthews E. , Mazur P. , Meneghelli A. , Mian A. , Morseth B. , Munguia-Izquierdo D. , Nyboe L. , O’Donoghue B. , Perram A. , Richards J. , Romain A. J. , Romaniuk M. , Sadeghi Bahmani D. , Sarno M. , Schuch F. , Schweinfurth N. , Stubbs B. , Uwakwe R. , Van Damme T. , Van Der Stouwe E. , Vancampfort D. , Vetter S. , Waterreus A. , Ward P. B.
Published: March 2020

Background

Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.

Methods

The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments.

Results

Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ.

Conclusions

The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals.
Prevalence of metabolic syndrome among ethnic groups in China
Authors: Qin Xuzhen , Qiu Ling , Tang Guodong , Tsoi Man-Fung , Xu Tao , Zhang Lin , Qi Zhihong , Zhu Guangjin , Cheung Bernard M. Y.
Published: March 2020

Background

Metabolic syndrome (MetS) is common in China, which has a multi-ethnic population of 1·3 billion. We set out to determine the prevalence of MetS and its components in different ethnic groups.

Methods

This nationwide cross-sectional survey involved 24,796 participants from eight ethnicities in six provinces in China from 2008 to 2011. MetS was defined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results were analysed using SPSS version 22·0 in 2018. Logistic regression was used for deriving odds ratios and 95% confidence intervals of risk factors for the MetS.

Results

The prevalence of MetS increased with age from 3·60% to 21·68%. After age standardization, the prevalence of MetS, in descending order, was 35·42% (Korean), 22·82% (Hui), 19·80% (Han), 13·72% (Miao), 12·90% (Tujia), 12·04% (Li), 11·61% (Mongolian), 6·17% (Tibetan). Korean ethnicity was associated with a higher prevalence in five components of MetS, while Tibetan ethnicity was associated with lower prevalence except decreased HDL cholesterol. Logistic regression analyses showed that age, drinking and being non-Tibetan were associated with a higher risk of MetS.

Conclusions

Within one country, albeit a large one, the prevalence of MetS can vary greatly. Chinese of Korean ethnicity had a much higher prevalence than Tibetan ethnicity. Measures to tackle MetS should be tailored to the ethnic groups within a population.
Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction
Authors: Schutt Russell K. , Woodford Mary Lou
Published: March 2020

Background

Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction.

Methods

Representative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects.

Results

After the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator.

Conclusions

Health care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.
Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories
Authors: Vanasse Alain , Courteau Josiane , Courteau Mireille , Benigeri Mike , Chiu Yohann M. , Dufour Isabelle , Couillard Simon , Larivée Pierre , Hudon Catherine
Published: March 2020

Background

Published methods to describe and visualize Care Trajectories (CTs) as patterns of healthcare use are very sparse, often incomplete, and not intuitive for non-experts.

Our objectives are to propose a typology of CTs one year after a first hospitalization for Chronic Obstructive Pulmonary Disease (COPD), and describe CT types and compare patients’ characteristics for each CT type.

Methods

This is an observational cohort study extracted from Quebec’s medico-administrative data of patients aged 40 to 84 years hospitalized for COPD in 2013 (index date). The cohort included patients hospitalized for the first time over a 3-year period before the index date and who survived over the follow-up period. The CTs consisted of sequences of healthcare use (e.g. ED-hospital-home-GP-respiratory therapists, etc.) over a one-year period. The main variable was a CT typology, which was generated by a ‘tailored’ multidimensional State Sequence Analysis, based on the “6W” model of Care Trajectories. Three dimensions were considered: the care setting (“where”), the reason for consultation (“why”), and the speciality of care providers (“which”). Patients were grouped into specific CT types, which were compared in terms of care use attributes and patients’ characteristics using the usual descriptive statistics.

Results

The 2581 patients were grouped into five distinct and homogeneous CT types: Type 1 (n = 1351, 52.3%) and Type 2 (n = 748, 29.0%) with low healthcare and moderate healthcare use respectively; Type 3 (n = 216, 8.4%) with high healthcare use, mainly for respiratory reasons, with the highest number of urgent in-hospital days, seen by pulmonologists and respiratory therapists at primary care settings; Type 4 (n = 100, 3.9%) with high healthcare use, mainly cardiovascular, high ED visits, and mostly seen by nurses in community-based primary care; Type 5 (n = 166, 6.4%) with high healthcare use, high ED visits and non-urgent hospitalisations, and with consultations at outpatient clinics and primary care settings, mainly for other reasons than respiratory or cardiovascular. Patients in the 3 highest utilization CT types were older, and had more comorbidities and more severe condition at index hospitalization.

Conclusions

The proposed method allows for a better representation of the sequences of healthcare use in the real world, supporting data-driven decision making.
Knowledge implementation in health care management: a qualitative study
Authors: Roohi G. , Mahmoodi G. , Khoddam H.
Published: March 2020

Background

The gap between knowledge and practice is a global issue, which increases wasteful spending in healthcare. There are several models and frameworks to address this gap and try to solve the challenge. Promoting Action on Research Implementation in Health Services (PARIHS) framework highlights the interaction of three main elements: evidence, context and facilitation, to implement research into practice, successfully. This framework can use as a tool to evaluate the situation and guide the changing. This study conducted to explain the status of knowledge implementation in Iran’s healthcare management system.

Methods

This qualitative study was done by using a directive content analysis approach through conducting in-depth, structured interviews with 15 health managers based on the PARIHS framework. Guiding questions were based on the three main elements of the framework: evidence, context and facilitation. The content of the interviews entered into the Qualitative Data Analysis software (MAXQDA version 10) and, then, analyzed.

Results

The most common source of evidence used by managers for decision-making was local information and previous experience. Evaluation more emphasized compared to other sub-elements of context, i.e. culture and leadership. In terms of facilitation, performing tasks by others was the dominant opinion.

Conclusion

Our results showed that managers in the healthcare system of Iran use their own and other manager’s experience and the local information for decision-making and have no ideas about facilitation.
Evidence-based policy making for health promotion to reduce the burden of non-communicable diseases in Moldova
Authors: Sécula Florence , Erismann Séverine , Cerniciuc Carolina , Chater Angel , Shabab Lion , Glen Fiona , Curteanu Ala , Serbulenco Aliona , Silitrari Natalia , Demiscan Daniela , Prytherch Helen
Published: March 2020

The Republic of Moldova faces several concurrent health challenges most notably an increase in chronic non-communicable diseases, spiralling health care costs and widening health inequalities. To accelerate progress in their resolution there is a need for new and innovative health promotion and behaviour change communication interventions. The Ministry of Health, Labour and Social Protection in collaboration with the newly created National Agency for Public Health held a conference on the occasion of theMoldovan National Day of Health Promotionon 14th March 2018 in which national and invited international experts exchanged their views on (1) best practice examples of behaviour change interventions, health promotion activities and lessons learned from the UK and elsewhere; and (2) possible ways forward for Moldova to implement cost-effective and evidence-based intersectoral health promotion programmes. The experts provided recommendations on implementing behaviour change interventions to reduce and prevent obesity; on the creation of a favourable tobacco control environment to reduce smoking prevalence; and on how physical activity programme design can benefit from health psychology research. All these strategies could foster health promotion activities and ultimately contribute to improving the health outcomes of the Moldovan population.
Functional Roles of Long Non-coding RNAs in Motor Neuron Development and Disease
Authors: Chen Kuan-Wei , Chen Jun-An
Published: March 2020

Long non-coding RNAs (lncRNAs) have gained increasing attention as they exhibit highly tissue- and cell-type specific expression patterns. LncRNAs are highly expressed in the central nervous system and their roles in the brain have been studied intensively in recent years, but their roles in the spinal motor neurons (MNs) are largely unexplored. Spinal MN development is controlled by precise expression of a gene regulatory network mediated spatiotemporally by transcription factors, representing an elegant paradigm for deciphering the roles of lncRNAs during development. Moreover, many MN-related neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA), are associated with RNA metabolism, yet the link between MN-related diseases and lncRNAs remains obscure. In this review, we summarize lncRNAs known to be involved in MN development and disease, and discuss their potential future therapeutic applications.
Sirtuin 1 inhibits lipopolysaccharide-induced inflammation in chronic myelogenous leukemia k562 cells through interacting with the Toll-like receptor 4-nuclear factor κ B-reactive oxygen species signaling axis
Authors: Wang Lei , Wang Mingming , Dou Hongju , Lin Wenjie , Zou Lifang
Published: March 2020

Background

Chronic myelogenous leukemia (CML) is a clonal myeloproliferative neoplasm resulting from BCR–ABL-transformed hematopoietic stem cells. Previous research has implicated multifunctional proinflammatory cytokines in CML development. It has been reported that Sirtuin 1 (SIRT1) as well as ADP-ribosyltransferase and deacetylase may influence CML cell viability and inflammation.

Methods

This study was directed toward exploring the SIRT1-involved in the mechanism of lipopolysaccharide (LPS)-triggered inflammation in CML k562 cells.

Results

In our study, the LPS-induced inflammation in k562 cells was reflected by increases in levels of diverse inflammatory cytokines, including interleukin (IL)-10, IL-1β, IL-6, interferon-γ, tumor necrosis factor (TNF)-α and TNF-β. LPS also decreased SIRT1 expression and nuclear location in k562 cells. Furthermore, SIRT1 overexpression inhibited the release of the above mentioned cytokines in LPS-treated cells. We also determined that LPS stimulation could activate Toll-like receptor 4 (TLR4), the nuclear factor κ B (NFκB) subunit, and p65 and produce reactive oxygen species (ROS) in k562 cells. Nevertheless, SIRT1 overexpression decreased TLR4 expression, thereby repressing the phosphorylation of the NFκB subunit and p65 and decreasing ROS production.

Conclusions

These findings suggest that SIRT1 is a latent therapeutic target for mitigating LPS-induced inflammation via the TLR4–NFκB–ROS signaling axis.
Dairy product consumption and hypertension risk in a prospective French cohort of women
Authors: Villaverde Paola , Lajous Martin , MacDonald Conor-James , Fagherazzi Guy , Boutron-Ruault Marie-Christine , Bonnet Fabrice
Published: March 2020

Background

Among potentially modifiable factors, dairy product consumption has been inconsistently associated with hypertension risk. The objective of this study was to investigate the relation between dairy product consumption and the risk of hypertension among middle-aged women.

Methods

In a prospective cohort of 40,526 French women, there were 9340 new cases of hypertension after an average 12.2 years of follow up. Consumptions of milk, yogurt, and types of cheese were assessed at baseline using a validated dietary questionnaire. Hazard ratios (HRs) and 95% confidence intervals (95% CI) for hypertension were estimated with multivariate Cox models with age as the time scale.

Results

The mean dairy consumption was 2.2 + 1.2 servings/day, as cottage cheese (0.2 + 0.2 servings/day), yogurt (0.6 + 0.5 servings/day), milk (0.4 + 0.7 servings/day), and cheese (1.1 + 0.8 servings/day). There was no association between risk of hypertension and total dairy consumption (multivariate HR for the fifth vs. first quintile HR5vs.1 = 0.97 [0.91; 1.04]). There was no association with any specific type of dairy, except for a positive association between processed cheese consumption and hypertension (multivariate HR4vs.1 = 1.12 [1.06; 1.18]; p trend = < 0.003).

Conclusions

In this large prospective cohort of French women, overall consumption of dairy products was not associated with the risk of hypertension. Results regarding processed cheese must be further confirmed.
Clinicopathologic analysis of renal cell carcinoma containing Intratumoral fat with and without osseous metaplasia
Authors: Xian Zhaoying , Orien Jason O. , Box Geoffrey N. , Zynger Debra L.
Published: March 2020

Background

There is minimal information regarding the prevalence of intratumoral adipose in renal cell carcinoma (RCC), and no study has assessed the impact of intratumoral adipose on the preoperative imaging diagnosis. The aim of this study was to investigate the prevalence and histopathologic characteristics of entrapped adipose with or without osseous metaplasia in RCC nephrectomy specimens and to determine if this finding impacted the preoperative imaging interpretation.

Methods

704 RCC specimens were prospectively evaluated for entrapped adipose and osseous metaplasia (423 partial nephrectomies, 281 total nephrectomies; 327 pT1a, 377 ≥ pT1b; 510 clear cell, 119 papillary, 30 chromophobe, 22 clear cell papillary, 23 other). Imaging reports were obtained, and the presence of intratumoral fat or calcification and the radiologic diagnostic impression were recorded.

Results

3% (n = 21) contained microscopically identified intratumoral adipose, with a similar frequency in the main histologic subtypes (p = 0.76). Mean metaplastic deposit size was 0.4 cm, mean deposit to capsule distance 0.2 cm, and 29% involved the tumor capsule. Histologically identified adipose was infrequently noted via imaging (13%), and only 1 case with histologically identified metaplasia had a radiologic diagnostic differential of angiomyolipoma (1/704, 0.1%).

Conclusion

While intratumoral adipose and/or osseous metaplasia can be observed within RCC, it is extremely rare for the radiologic diagnostic impression to have been confounded by histologically identified entrapped adipose. Awareness that metaplastic deposits are usually near the tumor capsule and may be minute could help prevent errors in diagnosis or staging.
Genome-wide analysis of constitutional DNA methylation in familial melanoma
Authors:   BIOS Consortium, Salgado Catarina , Gruis Nelleke , Heijmans Bastiaan T. , Oosting Jan , van Doorn Remco
Published: March 2020

Background

Heritable epigenetic alterations have been proposed as an explanation for familial clustering of melanoma. Here we performed genome-wide DNA methylation analysis on affected family members not carrying pathogenic variants in established melanoma susceptibility genes, compared with healthy volunteers.

Results

All melanoma susceptibility genes showed the absence of epimutations in familial melanoma patients, and no loss of imprinting was detected. Unbiased genome-wide DNA methylation analysis revealed significantly different levels of methylation in single CpG sites. The methylation level differences were small and did not affect reported tumour predisposition genes.

Conclusion

Our results provide no support for heritable epimutations as a cause of familial melanoma.
Geographical location and habitat predict variation in prokaryotic community composition of Suberites diversicolor
Authors: Ferreira Marina Rafaela Santos , Cleary Daniel Francis Richard , Coelho Francisco José Riso Costa , Gomes Newton Carlos Marcial , Huang Yusheng M , Polónia Ana Rita Moura , de Voogd Nicole Joy
Published: March 2020

Purpose

Marine lakes are unique habitats that house diverse assemblages of benthic and planktonic organisms including endemic species. In this study, we aimed to assess to what extent geographical location (Berau versus Papua) and the degree of marine lake connectivity (relatively open versus closed) to the surrounding marine environment structures the prokaryotic community composition of the sponge speciesSuberites diversicolor.

Methods

Sponge specimens were sampled in five marine lakes in Borneo and Papua and one open sea habitat in Taiwan.

Result

Prokaryotic communities ofS. diversicolorwere dominated by members assigned to the Proteobacteria (particularly Alphaproteobacteria and Gammaproteobacteria) and Cyanobacteria, which together made up from 78 to 87% of sequences in all samples. The dominant operational taxonomic units (OTUs) in most samples, OTUs 1 and 3, were both assigned to the alphaproteobacterial orderRhodospirillaleswith OTU-1 dominant in the marine lakes of Berau and Papua and OTU-3 in Taiwan. OTU-3 was also largely absent from Papuan samples but present in all Berau samples. Compositionally,S. diversicolorsamples clustered according to geographical location with the main axis of variation separating marine lake samples collected in Berau from those collected in Papua and the second axis of variation separating open sea samples collected in Taiwan from all marine lake samples. In addition, our results suggest that the degree of lake connectivity to the open sea also influences prokaryotic composition.

Conclusion

Although previous studies have shown that sponge-associated microbial communities tend to be stable across different geographical and environmental gradients, in the present study, both geography and local environmental conditions were significant predictors of variation in prokaryotic community composition ofS. diversicolor.
Prescription of CRRT: a pathway to optimize therapy
Authors: Karkar Ayman , Ronco Claudio
Published: March 2020

Severe acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression to chronic kidney disease (CKD), financial burden, and high mortality rate. Continuous renal replacement therapy (CRRT) is a predominant form of renal replacement therapy (RRT) in the intensive care unit (ICU) due to its accurate volume control, steady acid–base and electrolyte correction, and achievement of hemodynamic stability. This manuscript reviews the different aspects of CRRT prescription in critically ill patients with severe AKI, sepsis, and multiorgan failure in ICU. These include the choice of CRRT versus Intermittent and extended hemodialysis (HD), life of the filter/dialyzer including assessment of filtration fraction, anticoagulation including regional citrate anticoagulation (RCA), prescribed versus delivered CRRT dose, vascular access management, timing of initiation and termination of CRRT, and prescription in AKI/sepsis including adsorptive methods of removing endotoxins and cytokines.