bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraocular lens formula comparison in axial hyperopia with a high-power intraocular lens of 30 or more diopters
Authors: Kane Jack X. , Melles Ronald B.
Published: May 2020

Purpose:

To compare the accuracy of intraocular lens (IOL) power calculation formula predictions (Barrett Universal II, Emmetropia Verifying Optical [EVO] 2.0, Haigis, Hill-RBF 2.0, Holladay 1, Holladay 2, Hoffer Q, Kane, Olsen, and SRK/T) when using the Alcon SA60AT IOL of 30 or greater diopter (D) power.

Setting:

Kaiser Permanente, California, USA.

Design:

Multicenter retrospective consecutive case series.

Methods:

Data from patients having uneventful cataract surgery with insertion of a ≥30 D SA60AT IOL and preoperative LENSTAR 900 biometry were included. A single eye per qualifying patient was randomly selected for inclusion in the analysis. Lens constants were optimized using a large dataset of the same IOL model including the full range of axial lengths. The optimized lens constants were then used to calculate the predicted refraction for each formula, which was compared with the actual refractive outcome to give the prediction errors.

Results:

Included in the study were 182 eyes of 182 patients. From highest to lowest, the percentage of eyes with a prediction error within ±0.50 D was the Kane (58.8%), EVO 2.0 (57.7%), Haigis (55.5%), Holladay 2 (54.9%), Olsen (53.3%), Holladay 1 (50.5%), Hill-RBF 2.0 (43.9%), SRK/T (42.9%), Barrett Universal II (36.8%), and Hoffer Q (35.7%) formulas. The Kane formula had a statistically significant lower mean absolute prediction error compared with all formulas (P < .05) except the EVO 2.0 formula.

Conclusions:

The Kane formula had the lowest prediction error of the formulas studied, which was statistically significant compared with all formulas except the EVO 2.0 formula.
Prediction accuracy of IOL calculation formulas using the ASCRS online calculator for a diffractive extended depth-of-focus IOL after myopic laser in situ keratomileusis
Authors: Lwowski Christoph , Pawlowicz Katarzyna , Hinzelmann Lisa , Adas Mahmoud , Kohnen Thomas
Published: May 2020

Background:

To evaluate IOL calculation formulas provided by an online calculation tool from the ASCRS for an extended depth-of-focus (EDOF) IOL after previous myopic laser in situ keratomileusis (LASIK).

Setting:

Department of Ophthalmology, Goethe University, Frankfurt, Germany.

Design:

Retrospective consecutive case series.

Methods:

Patients who underwent cataract surgery or refractive lens exchange with implantation of a diffractive EDOF IOL and who had a history of myopic LASIK were included. Biometry, refractive data regarding the LASIK procedure, target refraction, and postoperative refraction were collected. Mean prediction error, mean absolute error (MAE), and the number of eyes within ±0.5 diopters (D), ±1.0 D, ±1.5 D, and ±2.0 D were calculated with the following formulas from the ASCRS calculator: Shammas, Haigis-L, Barrett True-K, Barrett No History, Masket, modified Masket, and the average of all formulas (average).

Results:

Twenty-five eyes matched the inclusion criteria. Mean spherical equivalent (SE) was −0.81 ± 0.69 D; the mean pre-LASIK SE was −6.4 ± 3.63 D. The formulas ranked by MAE were Shammas (0.7 ± 0.75 D), Haigis-L (0.72 ± 0.57 D), average (0.79 ± 0.8 D), Barrett True-K (1.14 ± 0.89 D), modified Masket (1.4 ± 1.15 D), Barrett No History (1.45 ± 0.7D ), and Masket (1.64 ± 1.27 D). The formulas with the most eyes within ±0.5 D were average (52%), Shammas (48%), and Haigis-L (44%) formulas.

Conclusions:

Calculation of IOLs in eyes with a history of refractive surgery remains a challenge. In this study, the Shammas and Haigis-L formulas performed best regarding MAE and percentage of eyes within ±0.5 D; however, the average of all formulas delivered reasonable results.
Brain gray matter abnormalities in osteoarthritis pain: a cross-sectional evaluation
Authors: Barroso Joana , Vigotsky Andrew D. , Branco Paulo , Reis Ana Mafalda , Schnitzer Thomas J. , Galhardo Vasco , Apkarian A. Vania
Published: May 2020

The interaction between osteoarthritis (OA) pain and brain properties remains minimally understood, although anatomical and functional neuroimaging studies suggest that OA, similar to other chronic pain conditions, may impact as well as partly be determined by brain properties. Here, we studied brain gray matter (GM) properties in OA patients scheduled to undergo total joint replacement surgery. We tested the hypothesis that brain regional GM volume is distinct between hip OA (HOA) and knee OA (KOA) patients, relative to healthy controls and moreover, that these properties are related to OA pain. Voxel-based morphometry group contrasts showed lower anterior cingulate GM volume only in HOA. When we reoriented the brains (flipped) to examine the hemisphere contralateral to OA pain, precentral GM volume was lower in KOA and HOA, and 5 additional brain regions showed distortions between groups. These GM changes, however, did not reflect clinical parameters. Next, we subdivided the brain into larger regions, approximating Brodmann areas, and performed univariable and machine learning-based multivariable contrasts. The univariable analyses approximated voxel-based morphometry results. Our multivariable model distinguished between KOA and controls, was validated in a KOA hold-out sample, and generalized to HOA. The multivariable model in KOA, but not HOA, was related to neuropathic OA pain. These results were mapped into term space (using Neurosynth), providing a meta-analytic summary of brain anatomical distortions in OA. Our results indicate more subtle cortical anatomical differences in OA than previously reported and also emphasize the interaction between OA pain, namely its neuropathic component, and OA brain anatomy.
Neural correlates of conditioned pain responses in fibromyalgia subjects indicate preferential formation of new pain associations rather than extinction of irrelevant ones
Authors: Sandström Angelica , Ellerbrock Isabel , Tour Jeanette , Kadetoff Diana , Jensen Karin Birgitta , Kosek Eva
Published: May 2020

Behavioral studies have demonstrated aberrant safety processing in fibromyalgia subjects (FMSs) and suggested that patients accumulate new potential pain-related threats more effectively than extinguishing no longer relevant ones. The aim of the current study was to investigate the neural correlates of conditioned pain responses and their relationship with emotional distress in FMS (n = 67) and healthy controls (HCs, n = 34). Using functional magnetic resonance imaging, we traced conditioned pain responses to an identical moderately painful pressure (P30) depending on whether it was following a green (P30green) or a red (P30red) cue. The cues were previously associated with individually calibrated painful pressure stimuli of low and high intensity, corresponding to visual analogue scale 10 and 50 mm, respectively. Fibromyalgia subjects displayed increased P30green ratings over time, while P30red ratings remained elevated. Healthy controls adapted all pain ratings to resemble moderate pain. Fibromyalgia subjects exhibited increased activation for [P30green>P30red] in M1/anterior insula, whereas HC showed increased S2/mid-insula response to [P30red>P30green]. High pain catastrophizing scale (PCS) ratings in fibromyalgia (FM) covaried with heightened brain activation for [P30green] × PCS in left dorsolateral prefrontal cortex and medial prefrontal cortex/orbitofrontal cortex; and [P30green>P30red] × PCS in dorsal anterior cingulate cortex/mid-cingulate cortex; superior temporal pole, extending to anterior insula; bilateral thalamus; and posterior insula. Psychophysiological interaction analysis for FM [P30green>P30red] × PCS revealed a dissociation in functional connectivity between thalamus and bilateral inferior parietal lobe. In alignment with behavioral data, FMS displayed a cerebral response suggesting preferential formation of new pain-related associations while simultaneously maintaining no longer relevant ones. The opposite was observed in HC. Increased responses to pain-related threats in FM may contribute to dysfunctional pain-protective behaviors and disability.
Assigning transcriptomic class in the trigeminal ganglion using multiplex in situ hybridization and machine learning
Authors: von Buchholtz Lars J. , Lam Ruby M. , Emrick Joshua J. , Chesler Alexander T. , Ryba Nicholas J.P.
Published: May 2020

Single cell sequencing has provided unprecedented information about the transcriptomic diversity of somatosensory systems. Here, we describe a simple and versatile in situ hybridization (ISH)-based approach for mapping this information back to the tissue. We illustrate the power of this approach by demonstrating that ISH localization with just 8 probes is sufficient to distinguish all major classes of neurons in sections of the trigeminal ganglion. To further simplify the approach and make transcriptomic class assignment and cell segmentation automatic, we developed a machine learning approach for analyzing images from multiprobe ISH experiments. We demonstrate the power of in situ class assignment by examining the expression patterns of voltage-gated sodium channels that play roles in distinct somatosensory processes and pain. Specifically, this analysis resolves intrinsic problems with single cell sequencing related to the sparseness of data leading to ambiguity about gene expression patterns. We also used the multiplex in situ approach to study the projection fields of the different neuronal classes. Our results demonstrate that the surface of the eye and meninges are targeted by broad arrays of neural classes despite their very different sensory properties but exhibit idiotypic patterns of innervation at a quantitative level. Very surprisingly, itch-related neurons extensively innervated the meninges, indicating that these transcriptomic cell classes are not simply labeled lines for triggering itch. Together, these results substantiate the importance of a sensory neuron's peripheral and central connections as well as its transcriptomic class in determining its role in sensation.
Slow depolarizing stimuli differentially activate mechanosensitive and silent C nociceptors in human and pig skin
Authors: Rukwied Roman , Thomas Christian , Obreja Otilia , Werland Fiona , Kleggetveit Inge Petter , Jorum Ellen , Carr Richard W. , Namer Barbara , Schmelz Martin
Published: May 2020

High-threshold mechanosensitive and mechanoinsensitive (“silent”) nociceptors have similar electrical thresholds for transcutaneous sine wave stimulation at 4 Hz that selectively activates cutaneous C nociceptors in human skin. Their fundamentally different functions particularly in chronic pain warrant differential stimulation protocols. We used transcutaneously delivered slow depolarizing stimuli (half-sine, 500 ms duration, 0.01-1 mA) in humans to assess intensity–response relations for the induction of pain psychophysically and recorded activation of mechanosensitive and silent nociceptors in healthy volunteers by microneurography. Differential C-fiber activation was confirmed in single-fiber recordings in pig allowing for stimulation amplitudes up to 10 mA. Perception and pain thresholds to half-sine wave pulses were 0.06 ± 0.03 mA and 0.18 ± 0.1 mA, respectively, and caused pain in an amplitude-dependent manner (n = 24). When matched for pain intensity, only sine wave stimulation induced an instant widespread axon reflex erythema (n = 10). In human microneurography, half-sine stimulation activated mechanosensitive nociceptors (n = 13), but only one of 11 silent nociceptors. In pig skin, the amplitude-dependent activation of mechanosensitive nociceptors was confirmed (0.2-1 mA, n = 28), and activation thresholds for most silent nociceptors (n = 13) were found above 10 mA. Non-nociceptive low-threshold mechanosensitive C fibers (n = 14) displayed lower activation thresholds for half-sine wave stimuli with an amplitude-dependent discharge increase between 0.01 and 0.1 mA. We conclude that transcutaneous electrical stimulation with 500-ms half-sine wave pulses between 0.2 and 1 mA causes amplitude-dependent pain by preferential activation of mechanosensitive C nociceptors.
Experience of Workplace Violence Toward Nursing Students in Iran: A Qualitative Study
Authors: Tee Stephen , Valiee Sina
Published: May 2020

Background and Aims

This study explored the dimensions of violence experienced by Iranian nursing students, during their nursing education. Violence toward students has become a major concern in recent years, and strategies are needed to reduce the incidence.

Methods

A qualitative study was conducted. Participants were seven male and nine female third-year undergraduate nursing students. Purposive sampling was used, and qualitative data from semistructured interviews were analyzed using thematic content analysis.

Results

From the qualitative data, five categories emerged: instances of violence, causes of violence, emotions after experiencing violence, reactions after violence, and violence prevention strategies.

Conclusion

To reduce the incidence of violence and provide safer learning environments, nursing students need to be taught preventive measures, but moreover, they need to receive appropriate support from nurses, instructors, and educational managers, Forensic nurses should be active stakeholders in monitoring, supporting, and referring nursing students who experience workplace violence.
An Evaluation of Verbal, Physical, and Sexual Violence Against Healthcare Workers in Ankara, Turkey
Authors: Demirci Şenol , Uğurluoğlu Özgür
Published: May 2020

Background

Healthcare professionals work in high-stress, fast-paced settings where individuals from different professions work together and who are exposed to many types of violence. The phenomenon of violence has become a concern of utmost importance for healthcare professionals that should be addressed with due attention.

Objectives

The aim of this study was to evaluate the verbal, physical, and sexual workplace violence experienced by healthcare professionals.

Methods

A survey was conducted in a public hospital in Ankara, Turkey, among 104 physicians, 93 nurses, and 150 other medical staff.

Results

Of the participating healthcare workers, 96.2%, 95.7%, and 80.7% of the physicians, nurses, and other medical personnel, respectively, reported having been exposed to verbal violence at least once in their professional life. Physicians were identified as a source of violence among other healthcare professionals. A logistic regression analysis was performed to determine the effects of sociodemographic features on violence. The statistically significant results showed that nurses are exposed to sexual violence more than other medical personnel are (OR = 3.11, 95% CI [1.29, 7.49]). Nurses were more exposed to verbal (OR = 5.08, 95% CI [1.54, 16.75]) and physical (OR = 3.68, 95% CI [1.15, 11.80]) violence compared with other medical personnel working in the hospital.

Conclusions

This study shows that a great majority of healthcare professionals are subjected to violence ranging from verbal violence in particular to physical and sexual violence.
Enhancing medication adherence in older adults at two nurse practitioner–owned clinics
Authors: Kulsick Cecily , Votta Jennie , Wright Wendy L. , White Patricia , Strowman Shelley
Published: May 2020

Background:

The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes.

Local problem:

A prior study at two nurse practitioner (NP)–owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker.

Methods:

Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers.

Intervention:

Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes.

Results:

Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change.

Conclusions:

This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.
Mentoring: A vital link in nurse practitioner development
Authors: Barker Elizabeth , Kelley Patricia Watts
Published: May 2020

Mentoring has been recognized in the discipline since the inception of nursing as a profession. The core elements of mentoring are a formal dyadic relationship, reciprocity, mutual respect, professional growth, personal development, trustworthiness, objectives, and a pathway to meet the objectives, clear expectations, shared values, personal connection, provision of a safe place for asking hard questions, navigation of roadblocks, and using lessons learned. Mentoring is important at all stages of professional development. Given that nursing is a profession dedicated to lifelong learning, mentoring can and should be employed at many stages of a career.
Managing emotional support animal letters in clinical practice
Authors: Thompson Summer , Elad Jennifer
Published: May 2020

The purpose of this brief report is to inform clinical practice and decision making in addressing the increased number of individuals requesting and receiving emotional support animal (ESA) waivers. It is important for providers including nurse practitioners to carefully consider the diagnostic and legal implications of endorsing ESAs. Nurse practitioners should be aware of the legal implications of writing ESA letters before providing them to their patients, understanding that a letter constitutes a determination of a disability. The literature on this topic is sparse, making it difficult to support the evidence-based practice of writing ESA letters. The therapeutic effects and benefits from human–animal interactions warrant further study in the case of ESAs to further support their use. Ultimately, it is up to the individual provider's clinical judgment supported by due diligence on a case-by-case basis should they decide to provide an ESA letter to their patient.
Is dual-phase SPECT/CT with 99mTc-sestamibi better than single-phase SPECT/CT for lesion localization in patients with hyperparathyroidism?
Authors: Lee Suk Hyun , Shin Eonwoo , Ha Sejin , Oh Jungsu S. , Song Dong Eun , Ryu Jin-Sook
Published: May 2020

This study aimed to establish an optimal protocol for 99mTc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT).

We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes and 120 minutes) 99mTc-sestamibi parathyroid scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT). Twenty seven patients had primary HPT, and 8 had secondary or tertiary HPT. Three nuclear medicine physicians independently analyzed the parathyroid images for lesion localization at 9 predefined parathyroid locations using the following 4 different image sets blinded to the clinical information:

All SPECT or SPECT/CT image sets were analyzed with dual-phase planar images. The image results were compared with the histopathological results after surgery.

Dual-phase SPECT/CT showed the highest positive rate of 85.7% in the patient-based analysis and 13.7% in the location-based analysis. Of 35 patients, surgical pathological results were available in 21 (16 adenomas in 16 primary HPTs and 16 hyperplasias in 5 secondary or tertiary HPTs). Dual-phase SPECT/CT showed the sensitivity values of 100% and 84.4% in the patient-based and location-based analysis, respectively, which were the highest sensitivity values among all image sets. In the primary HPT subgroup, dual-phase SPECT/CT showed the highest sensitivity value of 93.8% in the location-based analyses, whereas dual-phase SPECT, early SPECT/CT, and delayed SPECT/CT showed the sensitivity values of 62.5%, 81.3%, and 81.3%, respectively. In the secondary or tertiary HPT subgroup, dual-phase SPECT/CT also showed the highest sensitivity value of 75.0%, whereas early SPECT/CT, delayed SPECT/CT, and dual-phase SPECT showed the sensitivity values of 43.8%, 56.3%, and 68.8%, respectively.

Compared with dual-phase SPECT or single-phase SPECT/CT, the dual-phase SPECT/CT imaging protocol for 99mTc-sestamibi scintigraphy showed the highest positive rate and sensitivity, and was optimal for parathyroid lesion localization.
No association between abortion and risk of breast cancer among nulliparous women
Authors: Tong Huazhang , Wu Yifan , Yan Yin , Dong Yonghai , Guan Xihong , Liu Yun , Lu ZhiHui
Published: May 2020

Background:

Various epidemiological studies have demonstrated the association between abortion and risk of breast cancer among nulliparous women; however, results remain inconclusive. This meta-analysis assessed the association based on previous studies.

Methods:

PubMed, EMBase, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched for relevant articles until February 2018. In this meta-analysis, fixed-effects models were used to estimate the combined effect size and the corresponding 95% confidence interval (CI). All statistical data were analyzed using STATA 12.0.

Results:

A total of 14 articles consisting of 6 cohort studies and 8 case-control studies were included in this review. All articles were of high quality, as determined based on the Newcastle Ottawa Scale assessment. The combined risk ratio (RR) indicated no significant association between abortion and breast cancer among nulliparous women (RR = 1.023, 95%CI = 0.938–1.117; Z = 0.51, P = .607). Subgroup analyses revealed no significant associations between risk of breast cancer and induced abortion or between risk of breast cancer and spontaneous abortion (SA) among nulliparous women (RR = 1.008, 95% CI = 0.909-1.118 and RR = 1.062, 95%CI = 0.902-1.250, respectively). Neither 1 nor >2 abortions increased the risk of breast cancer among nulliparous women. Sensitivity analysis showed that our results were reliable and stable.

Conclusion:

Current evidence based on epidemiological studies showed no association between abortion and risk of breast cancer among nulliparous women.
Nontraumatic Multiple-Organ Fat Embolism
Authors: Meng Yunle , Zhang Mengzhen , Ling Haosen , Huang Shen , Miao Qi , Yu YanGeng , Zhang Fu , Qiu Pingming , Li Dongri
Published: May 2020

The patient was an 88-year-old woman with a 10-year history of hypertension. She was suspected to have been hit by a car. At the time of the event, she was conscious and able to stand on her own and had no obvious injuries. She was sent home, but she lapsed into unconsciousness and was nonresponsive after 2 hours. She was sent to the hospital, and her heartbeat and breathing stopped. After half an hour of rescue attempts, her heartbeat did not recover, and she was declared dead. During the autopsy, a small subcutaneous hemorrhage was observed below the right knee joint. No obvious internal organ injuries or bone fractures were observed. The deceased also had mild atherosclerosis in the coronary arteries and an old cerebral infarction in the right cerebellum. The tissue histopathological tests showed distinct fat embolism in multiple organs, including the brain, lungs, kidneys, liver, and pancreas. A postmortem blood biochemistry test of the heart blood showed that the levels of low-density lipoprotein, cholesterol, triglycerides, and free fatty acids in the blood were increased, and the level of C-reactive protein was elevated. According to the autopsy results, the direct cause of death was multiorgan fat embolism. This case suggests that aging, hypertension, and hyperlipidemia may be risk factors for nontraumatic fat embolism under stressful conditions.
Molecular Heterogeneity of Endometrioid Ovarian Carcinoma
Authors: Leskela Susanna , Romero Ignacio , Rosa-Rosa Juan M. , Caniego-Casas Tamara , Cristobal Eva , Pérez-Mies Belén , Gutierrez-Pecharroman Ana , Santón Almudena , Ojeda Belén , López-Reig Raquel , Palacios-Berraquero María L. , Andrada Encarna , Montes Santiago , Pastor Francisco , Gomez Maria C. , López-Guerrero José A. , Poveda Andrés , Palacios José
Published: May 2020

Endometrioid ovarian carcinoma (EOC) has clinical and biological differences compared with other histologic types of ovarian carcinomas, but it shares morphologic and molecular features with endometrioid endometrial carcinoma. To analyze the molecular heterogeneity of EOC according to the new molecular classification of endometrial cancer and to evaluate the prognostic significance of this molecular classification, we have analyzed 166 early-stage EOC by immunohistochemistry for mismatch repair proteins and p53 expression, and by Sanger sequencing for the exonuclease domain of polymerase epsilon (POLE EDM). In addition, we have carried out next-generation sequencing analysis of tumors with POLE EDM mutations to confirm the ultramutated profile. Eight tumors carried POLE EDM mutations and were classified as ultramutated (5%), 29 showed mismatch repair deficiency and were classified as hypermutated (18%), 16 tumors had a mutated pattern of p53 expression and were classified as p53 abnormal (11%), and 114 tumors did not have any of the previous alterations and were classified as no specific type (66%). Five tumors showed >1 classification criteria. The frequencies of ultramutated and hypermutated tumors were lower in EOC compared with the frequency reported in endometrial cancer. Subrogate molecular groups differed in both morphologic features (histologic grade, squamous and morular metaplasia, and necrosis) and immunohistochemical expression of several biomarkers (ARID1A, nuclear β-catenin, estrogen receptors, Napsin A, and HINF1B). In addition, the number of CD8+ tumor-infiltrating lymphocytes was higher in ultramutated and hypermutated tumors. The most commonly mutated genes in the ultramutated group were ARID1A (100%), PIK3R1, PTEN, BCOR, and TP53 (67% each), whereas no mutations were detected in KRAS. Although the prognosis did not differ among subgroups in the multivariate analysis, a trend toward a better prognosis in POLE-mutated and a worse prognosis in p53 abnormal tumors was observed. In addition, this classification could have important therapeutic implications for the use of immunotherapy in tumors classified as ultramutated and hypermutated.
The Association of Malnutrition and Disease Conditions in Mortality of Pediatric Patients Presenting to a Rural Emergency Department in Uganda
Authors: Ku Brandon C. , Zonfrillo Mark R. , Periyanayagam Usha , Bisanzo Mark , Rice Brian , Maling Samuel , Cohn Keri A.
Published: May 2020

Objectives

The main objectives of this study were to determine the effect of concurrent malnutrition on disease condition and the primary outcome of mortality in children younger than 5 years hospitalized after presenting to a rural emergency department (ED) in Uganda and to identify a high-risk patient population who may benefit from acute ED intervention.

Methods

A retrospective, observational study was performed to examine the effect of any form of malnutrition on the primary disease conditions of lower-respiratory tract infection (LRTI), malaria, and diarrheal illness. This study was conducted via review of a quality assurance database between January 2010 and July 2014.

Results

Of 3428 hospitalized children, the mean age (SD) was 19.8 months (13.9 months) and 56% were boys. Children diagnosed with malaria, an LRTI, or diarrheal illness all had a higher rate of mortality with concurrent malnutrition versus those without malnutrition (malaria, 6.2% [3.6–8.8%] vs 2.8% [2.0–3.7%]; P < 0.01; LRTI, 8.7% [5.0–12.4%] vs. 3.7% [2.6–4.9%], P < 0.01; and diarrheal illness, 10.9% [1.9–19.9%] vs 1.7% [0.1–3.4%], P < 0.01). In children with an LRTI or malaria with concurrent malnutrition, they were statistically significantly less likely to have abnormal temperature and heart rate during the ED encounter than those without concurrent malnutrition.

Conclusions

Based on these results, children with malnutrition and concurrent diseases with known high morbidity may not present with abnormal vital signs. This may have clinical relevance in patient management to the acute care provider in identifying and triaging children with malnutrition and acute disease conditions.
Implementing a Process to Systematically Identify and Address Poor Medication Adherence in Pediatric Liver Transplant Recipients
Authors: Wadhwani Sharad Indur , Nichols Melissa , Klosterkemper Jarrad , Cirincione Ross , Whitesell Kim , Owen Derek , Rengering Rebecca , Walz Benjamin , Heubi James , Hooper David K.
Published: May 2020

Objectives:

Poor adherence to medication following pediatric liver transplantation remains a major challenge, with some estimates suggesting that 50% of adolescent liver transplant recipients exhibit reduced medication adherence. To date, no gold standard has emerged to address this challenge; however, system interventions are most likely to be successful. We sought to implement a system to identify and address adherence barriers in a liver transplant clinic.

Methods:

Using structured quality improvement methods, including multiple plan-do-study-act cycles, we developed a system to screen for patients at risk of poor adherence, identify patient- and/or parent-reported barriers to adherence, and partner with patients to overcome identified barriers. We developed a process to track key outcomes, including the variability in tacrolimus trough levels and episodes of late acute cellular rejection.

Results:

The practice saw a total of 85 patients over 6 months, and about half were females. Over this period, the improvement team implemented this system-level process with high reliability (>90% of patients received the bundle of interventions). The most commonly identified adherence barrier by patients and caregivers was “forgetting.” The second most commonly identified adherence barrier by patients was that the medication “gets in the way of their activities,” whereas by caregivers, it was “difficulty swallowing pills.”

Discussion:

We identified challenges and opportunities to screen for poor adherence and identify patient- and/or caregiver-reported barriers to immunosuppression adherence. Identifying such barriers and partnering with patients to overcome those barriers using patient-centered, barrier-specific interventions could improve long-term graft survival through improved medication adherence.
Use of Coronary Artery Calcium Scoring to Improve Cardiovascular Risk Stratification and Guide Decisions to Start Statin Therapy in People Living With HIV
Authors: Pereira Branca , Mazzitelli Maria , Milinkovic Ana , Moyle Graeme , Ranasinghe Sachini , Mandalia Sundhyia , Pozniak Anton , Asboe David , Nelson Mark , Al-Hussaini Abhetale , Boffito Marta
Published: May 2020

Background:

Cardiovascular disease (CVD) risk assessment remains a critical step in guiding decisions to initiate primary prevention interventions in people living with HIV (PLWH).

Setting:

We investigated whether coronary artery calcium (CAC) scoring allowed a more accurate selection of patients who may benefit from statin therapy, compared with current risk assessment tools alone.

Methods:

Cross-sectional analysis of PLWH over 50 years old who underwent CAC scoring between 2009 and 2019. Framingham Risk score (FRS), QRISK2 and D:A:D scores were calculated for each participant at the time of CAC scoring and statin eligibility determined based on current European guidelines on the prevention of CVD in PLWH.

Results:

A total of 739 patients were included (mean age 56 ± 5, 92.8% male, 84% white). Among 417 (56.4%) candidates for statin therapy based on FRS ≥10%, 174 (23.5%) had no detectable calcification (CAC = 0). Conversely, 145 (19.6%) patients with detectable calcification (CAC > 0) were identified as low-risk (FRS < 10%). When compared with FRS, CAC scoring reclassified CVD risk in 43.1% of patients, 145 (19.6%) to a higher risk group that could benefit from statin therapy and 174 (23.5%) statin candidates to a lower risk group. QRISK2 and D:A:D scores performed similarly to FRS, underestimating the presence of significant coronary calcification in 21.1% and 24.9% respectively and overestimating risk in 16.9% and 18.8% patients with CAC = 0.

Conclusions:

Establishing a decision-model based on the combination of conventional risk tools and CAC scoring improves risk assessment and the selection of PLWH who would benefit from statin therapy.
Natural Killer Cells: Critical Effectors During Antibody-mediated Rejection of Solid Organ Allografts
Authors: Miyairi Satoshi , Baldwin William M. , Valujskikh Anna , Fairchild Robert L.
Published: May 2020

Antibody-mediated rejection (AMR) is an important cause of graft loss and continues to present a formidable obstacle to successful transplantation. Unresolved problems continue to be the absence of effective strategies to ablate the donor-specific antibody (DSA) response as well as to attenuate the antibody-mediated graft tissue injury. While the properties of DSA that cause greater graft tissue injury and the characteristic microvascular pathology of the graft injury are well documented, the mechanisms underlying the injury mediated by the antibodies remains unclear. Recent transcriptome interrogation of kidney and heart biopsies procured during ongoing AMR has indicated the expression of genes associated with natural killer (NK) cell activation that is absent during T cell–mediated rejection. The expression of NK cell transcripts during AMR correlates with the presence of CD56+ cells in the microcirculation inflammation observed during AMR. Several mouse models have recently demonstrated the role of NK cells in antibody-mediated chronic vasculopathy in heart allografts and the requirement for NK cell activation during acute AMR of kidney allografts. In the latter model, NK cell activation within kidney allografts is regulated by the activation of myeloid cells producing myeloperoxidase. Overall, the studies to date indicate that AMR constitutes a complex series of DSA-induced interactions with components of the innate immune response. The innate immune participants and their expressed effector functions resulting in the rejection are beginning to be identified. The identification of these components should uncover novel targets that can be used to attenuate acute graft tissue injury in the presence of DSA.
Associations of adiponectin and leptin with brain natriuretic peptide in African Americans: the Jackson Heart Study
Authors: Horbal Steven R. , Hall Michael E. , Dinh Paul C. , Smiley Abbas , Musani Solomon K. , Liu Jiankang , Taylor Herman A. , Fox Ervin R. , Bidulescu Aurelian
Published: May 2020

Background

Brain natriuretic peptide (BNP) is elevated in decompensated systolic and diastolic heart failure. The plasma levels of adipokines, such as adiponectin and leptin, may provide evidence for mechanistic differences in BNP concentrations. African-American-specific associations are limited in the literature. The objective of this study was to evaluate the associations of adiponectin and leptin with BNP among African Americans.

Methods

Linear and logistic regressions were used to test the associations between adiponectin, leptin, and plasma BNP in 3738 participants of the Jackson Heart Study (JHS), a single-site prospective cohort study of African Americans in Jackson, Mississippi.

Results

A direct relationship of adiponectin was observed in multiple multivariate-adjusted linear models: in men (β = 0.41–0.47), and in women (β = 0.32–0.38). Those in the highest quartile of adiponectin expression were twice as likely to have elevated BNP levels after adjustment [odds ratio 2.66 (95% confidence interval, 1.66–4.34)]. An inverse relationship of leptin with BNP was observed (β = −0.15) but attenuated after adjustment for aldosterone, renin, and adiponectin.

Conclusions

Different linear associations of adiponectin and leptin with BNP were observed. Odds of elevated adiponectin were observed with elevated BNP in multivariate-adjusted models. This paradoxical relationship of adiponectin and plasma BNP is possibly explained through adiponectin resistance.
Prevention and management of cardiovascular disease in patients with diabetes: current challenges and opportunities
Authors: Bruemmer Dennis , Nissen Steven E.
Published: May 2020

More than 100 million people in the USA have diabetes or prediabetes and are at high risk for developing cardiovascular disease. Current evidence-based guidelines support a multifactorial approach in patients with diabetes, including lifestyle intervention and pharmacological treatment of hyperglycemia, hypertension, and dyslipidemia. In addition, recent cardiovascular outcome trials demonstrated that sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists improve cardiovascular outcomes in patients with diabetes. Albeit this evidence, over 80% of patients with diabetes do not achieve the recommended treatment goals. Considering the rising burden of cardiovascular complications, there is need to improve the quality of care in patients with diabetes. In this review, we discuss the current quality of health care in patients with diabetes in the USA, identify barriers to achieve guideline-recommended treatment goals and outline opportunities for the improvement in caring for patients with diabetes.
Correlation between prevalence of tobacco smoking and risk and severity of COVID-19 at the national level in the European Union: an ecological study
Authors: González-Marrón Adrián , Martínez-Sánchez Jose M
Published: May 2020

The Angiotensin-converting enzyme 2 (ACE2) protein is the receptor for different coronaviruses, including Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19). Previous studies suggested the hypothesis that nicotine could downregulate the expression of the ACE2. Due to the high level of nicotine intake, the objective of this preliminary study was to assess, at the ecological level, the correlation between tobacco smoking and the attack rate and severity of COVID-19 in the European Union (EU). We have found that there is a statistically significant negative correlation between the age-standardized prevalence of tobacco smoking and the attack rate of COVID-19 in member states of the EU [Spearman’s correlation coefficient = −0.476 (95% confidence interval −0.117, −0.725) (p-value = 0.012)], meaning that in member states with a higher age-standardized prevalence of tobacco smoking the attack rate of COVID-19 has been so far lower. Further research is needed to understand the possible effect of nicotine exposure in the expression of the ACE2 protein.
Famotidine Use is Associated with Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study
Authors: Freedberg Daniel E. , Conigliaro Joseph , Sobieszczyk Magdalena E. , Markowitz David D. , Gupta Aakriti , O’Donnell Max R. , Li Jianhua , Tuveson David A. , Jin Zhezhen , Turner William C. , Landry Donald W. , Wang Timothy C. , Tracey Kevin J. , Callahan Michael V. , Abrams Julian A.
Published: May 2020

Background and Aims

The COVID-19 pandemic has caused widespread mortality and mortality. Famotidine is commonly used for gastric acid suppression but has recently gained attention as an antiviral that may inhibit SARS-CoV-2 replication. This study tested whether famotidine use is associated with improved clinical outcomes in patients with COVID-19 initially hospitalized to a non-intensive care setting.

Methods

This was a retrospective cohort study conducted among consecutive hospitalized patients with COVID-19 infection from February 25 to April 13, 2020 at a single medical center. The primary exposure was famotidine, received within 24 hours of hospital admission. The primary outcome was intubation or death. Propensity score matching was used to balance the baseline characteristics of patients who did and did not use famotidine.

Results

1,620 hospitalized patients with COVID-19 were identified including 84 (5.1%) who received famotidine within 24 hours of hospital admission. 340 (21%) patients met the study composite outcome of death or intubation. Use of famotidine was associated with reduced risk for death or intubation (adjusted hazard ratio (aHR) 0.42, 95% CI 0.21-0.85) and also with reduced risk for death alone (aHR 0.30, 95% CI 0.11-0.80). After balancing baseline patient characteristics using propensity score matching, these relationships were unchanged (HR for famotidine and death or intubation: 0.43, 95% CI 0.21-0.88). Proton pump inhibitors, which also suppress gastric acid, were not associated with reduced risk for death or intubation.

Conclusion

Famotidine use is associated with reduced risk of intubation or death in hospitalized COVID-19 patients. Randomized controlled trials are warranted to determine whether famotidine therapy improves outcomes in hospitalized COVID-19 patients.
Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients
Authors: Carlucci Philip M. , Ahuja Tania , Petrilli Christopher , Rajagopalan Harish , Jones Simon , Rahimian Joseph
Published: May 2020

Background

COVID-19 has rapidly emerged as a pandemic infection that has caused significant mortality and economic losses. Potential therapies and means of prophylaxis against COVID-19 are urgently needed to combat this novel infection. As a result of in vitro evidence suggesting zinc sulfate may be efficacious against COVID-19, our hospitals began using zinc sulfate as add-on therapy to hydroxychloroquine and azithromycin. We performed a retrospective observational study to compare hospital outcomes among patients who received hydroxychloroquine and azithromycin plus zinc versus hydroxychloroquine and azithromycin alone.

Methods

Data was collected from electronic medical records for all patients being treated with admission dates ranging from March 2, 2020 through April 5, 2020. Initial clinical characteristics on presentation, medications given during the hospitalization, and hospital outcomes were recorded. Patients in the study were excluded if they were treated with other investigational medications.

Results

The addition of zinc sulfate did not impact the length of hospitalization, duration of ventilation, or ICU duration. In univariate analyses, zinc sulfate increased the frequency of patients being discharged home, and decreased the need for ventilation, admission to the ICU, and mortality or transfer to hospice for patients who were never admitted to the ICU. After adjusting for the time at which zinc sulfate was added to our protocol, an increased frequency of being discharged home (OR 1.53, 95% CI 1.12-2.09) reduction in mortality or transfer to hospice remained significant (OR 0.449, 95% CI 0.271-0.744).

Conclusion

This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.

40-word summary: Zinc sulfate added to hydroxychloroquine and azithromycin may improve outcomes among hospitalized patients.
Social distancing and movement constraint as the most likely factors for COVID-19 outbreak control in Brazil
Authors: Baumgartner Matheus Tenório , Lansac-Tôha Fernando Miranda , Coelho Marco Túlio Pacheco , Dobrovolski Ricardo , Diniz-Filho José Alexandre Felizola
Published: May 2020

As thousands of new cases of COVID-19 have been confirmed, there is an increasing demand to understand the factors underlying the spread of this disease. Using country-level data, we modeled the early growth in the number of cases for over 480 cities in all Brazilian states. As the main findings, we found that the percentage of people respecting social distancing protocols was the main explanatory factor for the observed growth rate of COVID-19. Those cities that presented the highest spread of the new coronavirus were also those that had lower averages of social distancing. We also underline that total population of cities and connectivity, represented by the city-level importance to the air transportation of people across the country, plays important roles in the dissemination of SARS-CoV-2. Climate and socioeconomic predictors had little contribution to the big-picture scenario. Our results show that different States had high variability in their growth rates, mostly due to quite different public health strategies to retain the outbreak of COVID-19. In spite of all limitations of such a large-scale approach, our results underline that climatic conditions are likely weak limiting factors for the spread of the new coronavirus, and the circulation of people in the city- and country-level are the most responsible factors for the early outbreak of COVID-19 in Brazil. Moreover, we reinforce that social distancing protocols are fundamental to avoid critical scenarios and the collapse of healthcare systems. We also predict that economic-induced decisions for relaxing social distancing might have catastrophic consequences, especially in large cities.
Environmental sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a coronavirus disease (COVID-19) outbreak aboard a commercial cruise ship
Authors: Suzuki Motoi , Kamiya Hajime , Okamoto Kiyoko , Yamagishi Takuya , Kakimoto Kensaku , Takeda Makoto , Matsuyama Syutoku , Shirato Kazuya , Nao Naganori , Hasegawa Hideki , Kageyama Tsutomu , Takayama Ikuyo , Saito Shinji , Wakita Takaji , Ohnishi Makoto , Wada Koji , Fujita Retsu , Gu Yoshiaki , Matsunaga Nobuaki , Sakaguchi Mikiyo , Taichi Tajima R.N. , Ohmagari Norio , Takaya Saho , Saito Hiroki , Okinaka Keiji , Griffith Mathew , Parry Amy Elizabeth , Plucinski Mateusz M , Barnetson Brenda , Leonard James
Published: May 2020

Background

A COVID-19 outbreak occurred in a cruise ship with 3711 passengers and crew in 2020. This study is to test the hypothesis that environmental surfaces played important roles in transmission for SARS-CoV-2 during this outbreak.

Methods

We sampled environmental surfaces including air from common areas in the cruise ship and cabins in which confirmed COVID-19 cases and non-cases had stayed after they left the cabins. We tested the samples for SARS-CoV-2 by rt-PCR and conducted viral isolation.

Findings

Of 601 samples tested, SARS-CoV-2 RNA was detected from 58 samples (10%) from case-cabins from which they left 1-17 days before sampling, but not from non-case-cabins. Except for one sample from an air hood in a corridor, SARS-CoV-2 RNA was not detected from samples in common areas. SARS-CoV-2 RNA was not detected from all 14 air samples. RNA was most often detected on the floor around toilet in the bathroom (39%, 13/33, cycle quantification (Cq): 26.21-37.62) and bed pillow (34%, 11/32, Cq: 34.61-38.99). There was no difference in the detection proportion between cabins for symptomatic (15%, 28/189, Cq: 29.79-38.86) and asymptomatic cases (21%, 28/131, Cq: 26.21-38.99). No SARS-CoV-2 virus was isolated from any of the samples.

Interpretation

The environment around the COVID-19 cases was extensively contaminated from SARS-CoV-2 during COVID-19 outbreak in the cruise ship. Transmission risk of SARS-CoV-2 from symptomatic and asymptomatic patients seems to be similar and the environmental surface could involve viral transmission through direct contact.