bluuebunny/crossref_metadata_2025 huggingface dataset:
The feasibility of assessing cognitive and motor function in multiple sclerosis patients using robotics
Authors: Simmatis Leif ER , Jin Albert Y , Taylor Sean W , Bisson Etienne J , Scott Stephen H , Baharnoori Moogeh
Published: October 2020

Background

Multiple sclerosis (MS) causes pervasive motor, sensory and cognitive dysfunction. The Expanded Disability Status Scale (EDSS) is the gold standard for assessing MS disability. The EDSS is biased towards mobility and may not accurately measure MS-related disabilities in the upper limb or in cognitive functions (e.g. executive function).

Objective

Our objectives were to determine the feasibility of using the Kinarm robotic system to quantify neurological deficits related to arm function and cognition in MS patients, and examine relationships between traditional clinical assessments and Kinarm variables.

Methods

Individuals with MS performed 8 robotic tasks assessing motor, cognitive, and sensory ability. We additionally collected traditional clinical assessments and compared these to the results of the robotic assessment.

Results

Forty-three people with MS were assessed. Most participants could complete the robotic assessment. Twenty-six (60%) were impaired on at least one cognitive task and twenty-six (60%) were impaired on at least one upper-limb motor task. Cognitive domain task performance correlated most strongly with the EDSS.

Conclusions

Kinarm robotic assessment of people with MS is feasible, can identify a broad range of upper-limb motor and sensory, as well as cognitive, impairments, and complements current clinical rating scales in the assessment of MS-related disability.
A Nomogram for Predicting 30-day Mortality in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fractures
Authors: Crawford Zachary Thomas , Southam Brendan , Matar Robert , Avilucea Frank R. , Bowers Katherine , Altaye Mekibib , Archdeacon Michael T.
Published: October 2020

Introduction:

Femoral neck fractures in the elderly are increasingly common as a result of a growing geriatric population with 1-year mortality rates approaching 35%. While preoperative medical optimization and early time to surgery have reduced morbidity and mortality, patients with numerous medical comorbidities remain high risk for death in the perioperative period. Identifying those with greatest risk with a scoring system or nomogram may assist multidisciplinary teams in reducing mortality following hemiarthroplasty.

Purpose:

Identify predictors of 30-day mortality in elderly patients who underwent hemiarthroplasty for a femoral neck fracture to generate a predictive nomogram to determine the probability of post-operative mortality.

Methods:

Retrospective evaluation using data from the ACS-NSQIP database from 2005 to 2014 with CPT code 27125 for hip hemiarthroplasty. Multiple factors including demographics and comorbidities were compared in patients who experienced 30-day mortality and those who did not. T-test and chi-square tests were used to analyze data and a multivariate model was generated using logistic regression.

Results:

Advanced age (odds ratio (OR) 1.04), underweight BMI (OR 1.55), male sex (OR 1.80), reduced functional status (OR 2.04), heart failure within 30 days prior to surgery (OR 2.22), American Society of Anesthesiologists grade > 2 (OR > 2.50), disseminated cancer (OR 3.43) were all found to have statistically significant odds ratios for 30-day mortality following hemiarthroplasty.

Conclusion:

A tool based on easily identifiable risk factors, demographics, and comorbidities was developed that can help predict elderly patients who will experience mortality within 30 days of following hemiarthroplasty. In addition to identifying high risk patients, the nomogram can serve as a counseling tool for physicians to use with patients and their families to assist with better understanding of perioperative mortality risk.
“For Me, This Has Been Transforming”: A Qualitative Analysis of Interprofessional Relationship-Centered Communication Skills Training
Authors: Hirschmann Krista , Rosler Greta , Fortin VI Auguste H
Published: October 2020

In 2018, Yale Medicine (YM)—an academic multispecialty practice—and Yale New Haven Health System (YNHH), partnered with the Academy of Communication in Healthcare to develop a one-day interprofessional workshop to introduce relationship-centered communication skills to all of their nurses and physicians. Relationship-centered communication skills include showing positive regard, listening actively and expressing empathy and have been demonstrated to improve patient outcomes. A professionally diverse group of 12 nurses and physicians, committed to improving patient experiences, were purposefully selected for training to teach the workshop. Individual interviews with trainers 3 months post training revealed themes reflecting the intrapersonal, interpersonal, and organizational impact of participation in the Train-the-Trainer program. At the intrapersonal level, training contributed to personal growth, skillfulness, and confidence. At the interpersonal level, it expanded and strengthened professional networks. As an organizational catalyst, training transformed the work experience among nurse and physician trainers, thereby supporting YM/YNHH’s vision to provide interprofessional relationship-centered care. Results suggest that trainer training had additional benefits beyond learning to deliver the workshop, including improving the quality of trainers’ personal and professional relationships, and enhancing organizational efficiency and interprofessionalism.
Medical Teaching and Assessment in the Era of COVID-19
Authors: Monaghan Anthony Mark
Published: October 2020

The coronavirus pandemic has had a significant influence on medical education, most notably in terms of content delivery and provision of assessments. These unique times have facilitated the introduction of many new educational methods in medical schools globally each of which with potential merits and drawbacks. Importantly, the use of remote platforms to carry out online teaching has been especially vital in ensuring the continued training of doctors but other techniques such as telemedicine, online clinical case repositories and even virtual reality headsets are also being used to overcome these difficult circumstances. Some institutions also opted for open book written examinations raising issues surrounding this format’s legitimacy and potential benefits. Practical examinations are even harder to facilitate and although most were cancelled, this crisis may result in innovation which changes their future format. For example some may include audible clinical signs played online through a computer speaker to replace clinical examination. Overall, the COVID-19 pandemic has caused an overhaul of medical school orthodoxy that whilst disruptive, may serve to expose institutions to novel means of teaching and assessment which may ultimately improve medical education in future.
Evaluation and Management of Primary Tricuspid Regurgitation
Authors: Sudhakar B.G.K.
Published: October 2020

Tricuspid regurgitation (TR) is a highly prevalent echocardiographic finding in general population being present in almost 80% to 90% of them. However, TR is mild or functional rather than organic in majority of people. Significant TR was seen in 14.8% of adult men and 18.4% of adult women, respectively. Of all the significant TRs, approximately 8% to 10% are primary. Mild TR is benign but moderate-to-severe TR tends to progress and carries significant morbidity and mortality. Tricuspid valve disease is either primary or secondary (functional) in nature. Valve leaflets are predominantly diseased in primary TR, whereas annular dilatation is the main culprit in secondary TR. Of all the heart valves, tricuspid valve was the most neglected valve till a decade ago, though there was enough evidence to show that moderate to severe TR was not as benign as was assumed. With the availability of 2-dimensional echocardiography (2D echo) and transesophageal echocardiography, we are able to diagnose and determine the severity as well as etiology of TR. Although surgical therapy remains the gold standard for severe primary tricuspid valve disease, it continues to suffer from one of the highest morbidity and mortality rates among all cardiac valve-related surgeries even in the hands of experienced surgeons. For the same reason, majority of patients are not referred or subjected to surgical therapy. Therefore, there is an unmet need for less invasive and safer form of therapy to overcome this hurdle. So, several less-invasive and innovative technologies for treating patients with severe tricuspid valve disease at high surgical risk are being developed. Some of them have already been used for treatment of severe mitral regurgitation. They are being adopted for the treatment of severe TR. This review provides a comprehensive picture of newer guidelines and latest technologies and their impact on diagnosis and outcome of high-risk TV disease.
LDkit: a parallel computing toolkit for linkage disequilibrium analysis
Authors: Tang You , Li Zhuo , Wang Chao , Liu Yuxin , Yu Helong , Wang Aoxue , Zhou Yao
Published: October 2020

Background

Linkage disequilibrium (LD) analysis is broadly utilized in genetics to understand the evolutionary and demographic history and helps geneticists identify genes associated with interested inherited traits, such as diseases. There are some tools for linkage disequilibrium analysis either in a local or online way; however, there has been no such tool supporting both graphical user interface (GUI) and parallel computing.

Results

We developed a GUI software called LDkit for LD analysis, which supports parallel computing. The LDkit supports both variant call format (VCF) and PLINK ‘ped + map’ format. At the same time, users could also just analyze a subset of individuals from the whole population. The LDkit reads the data by block and then paralleled the computation process by monitoring the usage of processes. Assessment on the Human 1000 genome data showed that when paralleled with 32 threads, the running time was reduced to less than 6 minutes from ~77 minutes using the chromosome 22 dataset with 1,103,547 SNPs and 2504 individuals.

Conclusions

The software LDkit can be effectively used to calculate and plot LD decay, LD block, and linkage disequilibrium analysis between a site and a given region. Most importantly, both graphical user interface (GUI) and stand-alone packages are available for users’ convenience. LDkit was written in JAVA language under cross-platform support.
The skill of tracheal intubation with rigid scopes – a randomised controlled trial comparing learning curves in 740 intubations
Authors: Theiler Lorenz , Greif Robert , Bütikofer Lukas , Arheart Kristopher , Kleine-Brueggeney Maren
Published: October 2020

Background

Rigid scopes are successfully used for management of difficult airways, but learning curves have not been established.

Methods

This randomised controlled trial was performed at the University Hospital Bern in Switzerland to establish learning curves for the rigid scopes Bonfils and SensaScope and to assess their performance. Fifteen consultant anaesthetists and 15 anaesthesia registrars performed a total of 740 intubations (10 to 20 intubations with each device per physician) in adult patients without predictors of a difficult airway under general anaesthesia. According to randomisation, physicians intubated the patient’s trachea with either the Bonfils or the SensaScope. A maximum of three intubation attempts was allowed. Primary outcome was overall time to successful intubation. Secondary outcome parameters included first attempt success, first attempt success within 60 s, failures and adverse events.

Results

A clear learning effect was demonstrated: Over 20 trials, intubations became 2.5-times quicker and first attempt intubation success probability increased by 21–28 percentage points. Fourteen and 20 trials were needed with the Bonfils and the SensaScope, respectively, to reach a 90% first attempt success probability. Intubation times were 23% longer (geometric mean ratio 1.23, 95% confidence interval 1.12–1.36, p < 0.001) and first attempt success was less likely (odds ratio 0.64, 95% confidence interval 0.45–0.92, p = 0.016) with the SensaScope. Consultants showed a tendency for a better first attempt success compared to registrars. Overall, 23 intubations (10 Bonfils, 13 SensaScope) failed. Adverse events were rare and did not differ between devices.

Conclusions

A clear learning effect was demonstrated for both rigid scopes. Fourteen intubations with the Bonfils and 20 intubations with the SensaScope were required to reach a 90% first attempt success probability. Learning of the technique seemed more complex with the SensaScope compared to the Bonfils.

Trial registration

Current Controlled Trials, ISRCTN14429285. Registered 28 September 2011, retrospectively registered.
Determinants of referral of women with urinary incontinence to specialist services: a national cohort study using primary care data from the UK
Authors: Gurol-Urganci Ipek , Geary Rebecca S. , Mamza Jil B. , Iwagami Masao , El-Hamamsy Dina , Duckett Jonathan , Wilson Andrew , Tincello Douglas , van der Meulen Jan
Published: October 2020

Background

Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. This study aimed to investigate characteristics associated with referrals from primary to specialist secondary care for urinary incontinence.

Methods

We carried out a cohort study, using primary care data from over 600 general practices contributing to the Clinical Practice Research Datalink (CPRD) in the United Kingdom. We used multi-level logistic regression to estimate adjusted odds ratios (aOR) that reflect the impact of patient and GP practice-level characteristics on referrals to specialist services in secondary care within 30 days of a urinary incontinence diagnosis. All women aged ≥18 years newly diagnosed with urinary incontinence between 1 April 2004 and 31 March 2013 were included. One-year referral was estimated with death as competing event.

Results

Of the 104,466 included women (median age: 58 years), 28,476 (27.3%) were referred within 30 days. Referral rates decreased with age (aOR 0.34, 95% CI 0.31–0.37, comparing women aged ≥80 with those aged 40–49 years) and was lower among women who were severely obese (aOR 0.84, 95% CI 0.78–0.90), smokers (aOR 0.94, 95% CI 0.90–0.98), women from a minority-ethnic backgrounds (aOR 0.76, 95% CI 0.65–0.89 comparing Asian with white women), women with pelvic organ prolapse (aOR 0.77, 95% CI 0.68–0.87), and women in Scotland (aOR 0.60, 95% CI 0.46–0.78, comparing women in Scotland and England). One-year referral rate was 34.0% and the pattern of associations with patient characteristics was almost the same as for 30-day referrals.

Conclusions

About one in four women with urinary incontinence were referred to specialist secondary care services within one month after a UI diagnosis and one in three within one year. Referral rates decreased with age which confirms concerns that older women with UI are less likely to receive care according to existing clinical guidelines. Referral rates were also lower in women from minority-ethnic backgrounds. These finding may reflect clinicians’ beliefs about the appropriateness of referral, differences in women’s preferences for treatment, or other factors leading to inequities in referral for urinary incontinence.
Determinants of participation in a post-hospitalization physical exercise program for older adults
Authors: Urquiza Miriam , Echeverria Iñaki , Besga Ariadna , Amasene María , Labayen Idoia , Rodriguez-Larrad Ana , Barroso Julia , Aldamiz Mikel , Irazusta Jon
Published: October 2020

Background

Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients.

Methods

A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people ≥70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model.

Results

Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07–1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69–0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08–0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables.

Conclusions

This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12619000093189, (date: January 22, 2019, retrospectively registered).
Differential diagnosis of atypical encephalopathy in critical care: a case report
Authors: Li Chung , Peng Ming-Yieh , Chang Chia-Hui , Hsu Yuan-Yu , Hsieh Min-Shiau , Lin Shinn-Kuang , Lee Yi-Hsin , Yang Mei-Chen
Published: October 2020

Background

A lower level of consciousness is a common presentation in critical care, with many different causes and contributory factors, of which more than one may be present concurrently.

Case presentation

We described a woman with poorly controlled diabetes and steroid-dependent asthma who presented in a deep coma. She was found to have Streptococcus intermedius bacteremia and pyogenic ventriculitis that originated from right middle lobe pneumonia. Also, multiple small parenchymal lesions were observed on brain magnetic resonance imaging and increased protein concentration was noted in cerebral spinal fluid. Initially, her coma was thought to be due to diabetic ketoacidosis and septic encephalopathy. However, her lowered level of consciousness was disproportionate to either diabetic ketoacidosis or septic encephalopathy, and her clinical course was not as expected for these two conditions. Treatment with antibiotic, corticosteroid and antihelminthic drugs was administered resulting in improving consciousness. The Streptococcus intermedius pneumonia progressed to form a large cavity that needed an early surgical lobectomy and resulted in the unexpected diagnosis of chronic cavitary pulmonary aspergillosus.

Conclusions

In critical care, a lowered level of consciousness may have many etiologies, and critical care clinicians should be familiar with the signs and symptoms of all possible causes to enable prompt diagnosis and appropriate treatment.
Role of circulating free DNA in evaluating clinical tumor burden and predicting survival in Chinese metastatic colorectal cancer patients
Authors: Xu Xiaojing , Yu Yiyi , Shen Minna , Liu Mengling , Wu Shengchao , Liang Li , Huang Fei , Zhang Chenlu , Guo Wei , Liu Tianshu
Published: October 2020

Background

The aim of this study was to explore the utility of circulating free DNA (cfDNA) in the evaluation of clinical tumor burden and survival in Chinese patients with metastatic colorectal cancer (mCRC) and to preliminarily summarize some metastatic characteristics associated with mutational status.

Methods

A panel covering a total of 197 hotspot mutations of KRAS, NRAS, BRAF and PIK3CA was used to evaluate the mutational status in plasma by next-generation sequencing (NGS) technology in 126 patients with mCRC. An amplification-refractory mutation system (ARMS) was used to analyze genomic DNA from matched tissue samples. Clinical markers including carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) in serum and the sum of all tumor diameters on CT or PET/CT were collected to indicate clinical tumor burden. The correlations between cfDNA and clinical tumor burden were analyzed using Pearson correlation and linear regression models. The median progression-free survival (PFS) and 1-year overall survival (OS) rates were calculated by Kaplan-Meier (K-M) survival analysis.

Results

Of the 126 enrolled patients, patients who were tested positive for mutations in plasma accounted for 45.2% (57/126). Mutations in KRAS, NRAS, BRAF and PIK3CA were detected in 37.3% (47/126), 1.6% (2/126), 3.2% (4/126) and 13.5% (17/126) of patients, respectively. The overall concordance rate of mutational status between plasma and matched tissues was 78.6% (99/126). Sixteen patients had mutations in plasma that were not detected in tissue, including some rare hotspot mutations. The cfDNA concentration was significantly correlated with the levels of clinical markers, especially CEA (P < 0.0001, Pearson r = 0.81), LDH (P < 0.0001, Pearson r = 0.84) and the sum of tumor diameters (P < 0.0001, Pearson r = 0.80). Patients with a high cfDNA concentration (> 17.91 ng/ml) had shorter median progression-free survival (6.6 versus 11.7 months, P < 0.0001) and lower 1-year overall survival rate (56% versus 94%, P < 0.0001) than those with a low cfDNA concentration (≤17.91 ng/ml). The most common metastatic site was the liver (77.8%), followed by the lymph nodes (62.7%), lung (40.5%), peritoneum (14.3%) and bone (10.3%), in all patients. There was no significant difference in metastasis between different mutational statuses.

Conclusion

Analyzing mutations in plasma could provide a more comprehensive overview of the mutational landscape than analyzing mutations in tissue. The cfDNA concentration could be a quantitative biomarker of tumor burden and could predict survival in Chinese patients with mCRC.
Factors associated with cyber-victimization among immigrants and non-immigrants in Canada: a cross-sectional nationally-representative study
Authors: Kenny Kathleen S. , Merry Lisa , Brownbridge Douglas A. , Urquia Marcelo L.
Published: October 2020

Objectives

There is a paucity of research on patterns of cyber-victimization in minority groups, including immigrants. This study aimed to identify individual, interpersonal and contextual characteristics associated with cyber-victimization among immigrants and non-immigrants.

Methods

We drew on nationally representative data from adolescents and adults in the Canadian General Social Survey on victimization (2014). We used multivariable logistic regression to identify potential factors associated with cyber-victimization in the last 12 months, stratified by immigrant status and sex.

Results

Among 27,425 survey respondents, the weighted prevalence of cyber-victimization in the last 12 months was 2.1% among immigrants and 2.3% among non-immigrants. Cyber-victimization rates differed significantly by sex among immigrants (2.8% for males vs. 1.4% for females), but not among non-immigrants (2.1% for males vs. 2.4% for females). While most other factors associated with cyber-victimization were similar for immigrants and non-immigrants, there were pronounced associations of past child maltreatment (adjusted prevalence odds ratio [aPOR] 4.85, 95% confidence interval [CI] 2.76, 8.52) and residence in an unwelcoming neighbourhood (aPOR 5.08, 95% CI 2.44, 10.55) with cyber-victimization among immigrants that were diminished or absent among non-immigrants. Additionally, sex-stratified analyses among immigrants showed cyber-victimization to be strongly associated with having a mental health condition (aPOR 3.50, 95% CI 1.36, 8.97) among immigrant males only, and with perceived discrimination (aPOR 4.08, 95% CI 1.65, 10.08), as well as being under 24 years old (aPOR 3.24, 95% CI 1.09, 9.60) among immigrant females.

Conclusions

Immigration status and sex were differentially associated with cyber-victimization. Findings support the salience of a social-ecological perspective and gender-stratified analyses to better elucidate complex pathways linking cyber-victimization to potential gender-based health inequities among immigrants.
Low dispersion in the infectiousness of COVID-19 cases implies difficulty in control
Authors: He Daihai , Zhao Shi , Xu Xiaoke , Lin Qiangying , Zhuang Zian , Cao Peihua , Wang Maggie H. , Lou Yijun , Xiao Li , Wu Ye , Yang Lin
Published: October 2020

The individual infectiousness of coronavirus disease 2019 (COVID-19), quantified by the number of secondary cases of a typical index case, is conventionally modelled by a negative-binomial (NB) distribution. Based on patient data of 9120 confirmed cases in China, we calculated the variation of the individual infectiousness, i.e., the dispersion parameterkof the NB distribution, at 0.70 (95% confidence interval: 0.59, 0.98). This suggests that the dispersion in the individual infectiousness is probably low, thus COVID-19 infection is relatively easy to sustain in the population and more challenging to control. Instead of focusing on the much fewer super spreading events, we also need to focus on almost every case to effectively reduce transmission.
Association between social capital and depression among older people: evidence from Anhui Province, China
Authors: Bai Zhongliang , Xu Zhiwei , Xu Xiaoru , Qin Xia , Hu Wenbiao , Hu Zhi
Published: October 2020

Background

To examine the relationship between social capital and depression among community-dwelling older adults in Anhui Province, China.

Methods

A cross-sectional study was conducted among older people selected from three cities of Anhui Province, China using a multi-stage stratified cluster random sampling method. Data were collected through questionnaire interviews and information on demographic characteristics, social capital, and depression was collected. The generalized linear model and classification and regression tree model were employed to assess the association between social capital and depression.

Results

Totally, 1810 older people aged ≥60 years were included in the final analysis. Overall, all of the social capital dimensions were positively associated with depression: social participation (coefficient: 0.35, 95% CI: 0.22–0.48), social support (coefficient:0.18, 95% CI:0.07–0.28), social connection (coefficient: 0.76, 95% CI:0.53–1.00), trust (coefficient:0.62, 95% CI:0.33–0.92), cohesion (coefficient:0.31, 95% CI:0.17–0.44) and reciprocity (coefficient:0.30, 95% CI:0.11–0.48), which suggested that older people with higher social capital had a smaller chance to develop depression. A complex joint effect of certain social capital dimensions on depression was also observed. The association with depression and the combinative effect of social capital varied among older adults across the cities.

Conclusions

Our study suggests that improving social capital could aid in the prevention of depression among older adults.
The role of medical equipment in the spread of nosocomial infections: a cross-sectional study in four tertiary public health facilities in Uganda
Authors: Ssekitoleko Robert T. , Oshabaheebwa Solomon , Munabi Ian G. , Tusabe Martha S. , Namayega C. , Ngabirano Beryl A. , Matovu Brian , Mugaga Julius , Reichert William M. , Joloba Moses L.
Published: October 2020

Background

With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda.

Methods

A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14.

Results

A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives.

Conclusion

These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There’s also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.
Scoliosis in Goldenhar syndrome with curve reversal during brace treatment: a case report
Authors: Uehara Masashi , Kuraishi Shugo , Ikegami Shota , Oba Hiroki , Takizawa Takashi , Munakata Ryo , Hatakenaka Terue , Mimura Tetsuhiko , Takahashi Jun
Published: October 2020

Background

Goldenhar syndrome sometimes displays progressive scoliosis and other spinal deformities that require treatment. However, few reports exist on scoliosis correction in Goldenhar syndrome. We described the rare radiological outcomes of a patient with Goldenhar syndrome who received brace treatment for scoliosis.

Case presentation

A 4-year-old boy was diagnosed as having Goldenhar syndrome and referred to our hospital for scoliosis treatment. The deformity deteriorated gradually, and left convex scoliotic angle was 26 degrees (T3-L2) at 11 years of age. Unexpectedly during treatment with an orthopedic brace, the curve had reversed to 21 degrees (T5-L2) at 7 months of therapy. After another adjustment of the brace, his right convex scoliotic angle improved to 13 degrees (T4-L2) at 15 months of treatment.

Conclusions

Curve reversal may occur during brace treatment for scoliosis in Goldenhar syndrome. Clinicians may opt to periodically check curve correction despite the risk of increased radiation exposure.
Association between factors related to the pregnancy, neonatal period, and later complications (especially asthma) and menarcheal age in a sample of Lebanese girls
Authors: Sakkal Josephine , Hallit Souheil , Nicolas Georges
Published: October 2020

Background

Studies about the majority of the factors that may potentially influence the pubertal timing and menarche were controversial. The objective was to evaluate the association between factors related to the pregnancy, neonatal period, and the complications that may happen later in life and the menarcheal age in a sample of Lebanese girls admitted or not to the NICU at birth. Our secondary objective was to try to find, for the first time in literature, a correlation between respiratory distress at birth and the need of oxygen therapy with the age of the first menses in these girls.

Methods

It is a cross-sectional retrospective study, conducted between January and March 2019. Our sample included all the 2474 girls born in Notre-Dame-de-Secours hospital, between 2000 and 2005; the sample consisted of 297 girls (97 girls admitted to the NICU and 200 randomly chosen to participate in our study with a ratio of 1:2 (1 girl admitted to the NICU vs 2 girls born in the nursery).

Results

Asthma later in life was significantly associated with lower age at menarche in girls, whereas a higher mother’s age at menarche and a higher gestational age were significantly associated with higher age at menarche in girls. When taking each cause of NICU admission as an independent variable, showed that a higher mother’s age at menarche was significantly associated with higher age at menarche in girls, whereas a higher number of days of phototherapy, a preeclampsia in the mother during pregnancy and asthma later in life in the girl were significantly associated with a lower age at menarche in girls.

Conclusion

The timing of menarche seems to be associated with many factors in Lebanese girls that should not be disregarded by physicians.
Managerial features and outcome in neonatal intensive care units: results from a cluster analysis
Authors: Fanelli Simone , Bellù Roberto , Zangrandi Antonello , Gagliardi Luigi , Zanini Rinaldo
Published: October 2020

Background

Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes.

Methods

The research was conducted in Italy, within the SONAR project. SONAR’s aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs.

Results

Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the “traditional” model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The “collaborative” model has as key elements professional specialisation and functional coordination. The “individualistic” model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness.

The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model.

Conclusions

Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes.
LINC01089 is a tumor-suppressive lncRNA in gastric cancer and it regulates miR-27a-3p/TET1 axis
Authors: Guo Xufeng , Li Ming
Published: October 2020

Background

Gastric cancer (GC) is one of the most common malignancies around the world. Recently, the role of long non-coding RNA (lncRNA) in cancer biology has become a hot research topic. This work aimed to explore the biological function and underlying mechanism of LINC01089 in GC.

Methods

Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to investigate the expression of LINC01089 in GC tissues and cells. The relationship between the expression level of LINC01089 and the clinicopathological parameters of GC was assessed. Cell models of LINC01089 overexpression, LINC01089 knockdown, miR-27a-3p overexpression, and miR-27a-3p inhibition were established by transfection. CCK-8 assay, BrdU assay, and Transwell assay were utilized to investigate the malignant biological behaviors of GC cell lines after transfection. Dual luciferase activity reporter assay, Pearson’s correlation analysis, and Western blot were utilized to the regulatory relationships among LINC01089, miR-27a-3p and tet methylcytosine dioxygenase 1 (TET1).

Result

LINC01089 down-regulation was observed in GC tissues and cell lines. Low expression level of LINC01089 in GC tissues was markedly linked to larger tumor size, higher T stage, as well as lymphatic metastasis of the patients. Functional experiments implied that LINC01089 overexpression impeded the proliferation, migration, as well as invasion of GC cells, whereas LINC01089 knockdown promoted the above malignant phenotypes. Additionally, up-regulation of miR-27a-3p was also observed in GC tissues. Functional experiments also showed that, miR-27a-3p overexpression boosted the malignant biological behaviors of GC cells; on the contrast, these phenotypes were impeded by miR-27a-3p inhibition. Moreover, LINC01089 interacted with and repressed miR-27a-3p, and miR-27a-3p antagonized the impact of LINC01089 on GC cells. Additionally, TET1 was verified as a target gene of miR-27a-3p, and could be positively regulated by LINC01089.

Conclusion

LINC01089 impedes the proliferation, migration, and invasion of GC cells by adsorbing miR-27a-3p and up-regulating the expression of TET1.
A latent class analysis of dietary behaviours associated with metabolic syndrome: a retrospective observational cross-sectional study
Authors: Park Jung Ha , Kim Ju Young , Kim So Hye , Kim Jung Hyun , Park Young Mi , Yeom Hye Seon
Published: October 2020

Background

Obesity defined solely by the Body Mass Index (BMI) may not reflect the true heterogeneity of the obese population. This study aimed to classify the dietary behaviours of overweight and obese individuals and to explore the relationship between patterns of dietary behaviour and cardiometabolic risk factors.

Methods

A total of 259 patients who visited an outpatient weight management clinic at a tertiary hospital and underwent a dietary behaviour assessment between January 2014 and February 2019 were enrolled in the study. Dietary behaviours were assessed in three domains with nine categories, including choice of food (frequently eating out and consumption of instant/fast/takeaway food), eating behaviour (irregular meals; frequent snacking, including eating at night; emotional eating; and overeating/binge eating), and nutrient intake (high-fat/high-calorie foods, salty food, and poorly balanced diet). Latent class analysis (LCA) was used to classify the subjects according to these categories. Associations between latent class and metabolic syndrome were assessed by logistic regression.

Results

The subjects were classified into three LCA-driven classes, including a referent class of healthy but unbalanced eaters (n = 118), a class of emotional eaters (n = 53), and a class of irregular unhealthy eaters (n = 88). Compared with the referent class, emotional eaters had a significantly higher BMI (beta = 3.40,P < 0.001) accompanied by metabolic syndrome (odds ratio 2.88, 95% confidence interval 1.16–7.13).

Conclusions

Our three LCA-driven obesity phenotypes could be useful for assessment and management of obesity and metabolic syndrome. The association between emotional eaters and higher BMI and metabolic syndrome was stronger than that with other eaters. Thus, emotional regulation strategies might have benefit for emotional eater’s diet.
Coagulopathy associated with COVID-19 – Perspectives & Preventive strategies using a biological response modifier Glucan
Authors: Ikewaki Nobunao , Rao Kosagi-Sharaf , Archibold Armando Durant , Iwasaki Masaru , Senthilkumar Rajappa , Preethy Senthilkumar , Katoh Shojiro , Abraham Samuel J. K.
Published: October 2020

Direct endothelial injury by viruses and dysregulation of clotting mechanisms due to cytokine storm are the major precipitating factors of mortality in COVID-19; both are attributed to a fundamental dysregulation of the immune system. While immune dysregulation can be attributed to several factors, the risk of associated thrombogenic disruption varies across individuals. This variation depends on several factors, such as comorbidities, including diabetes, hypertension, and cardiovascular diseases. When considering ethnic variations, the vulnerability of Caucasians, African Americans and Hispanics needs to be addressed before arriving at strategies to handle thromboembolic complications, which have been identified in recent reports as the leading causes of mortality in COVID-19. Although evaluation of D-dimer and prothrombin during admission is considered to predict prognosis and mortality, there are no preventive or prophylactic strategies before hospital admission. Herein, we present our perspectives on the effect of regular supplementation with the biological response modifier beta glucan based on its relevance to immune modulation. This effect is of paramount importance in decreasing the development of severe COVID-19 and reducing mortality against the background of coagulopathy, especially in vulnerable populations.
The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older: a prospective cohort study
Authors: Hu Wen , Xu Dong , Li Juan , Chen Cheng , Chen Yuan , Xi Fangfang , Zhou Feifei , Guo Xiaohan , Zhao Baihui , Luo Qiong
Published: October 2020

Background

This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE.

Methods

It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12,451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 h including D-dimer level, platelet counts and fibrinogen level were collected for analyses.

Results

30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 h of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR = 5.874, 95%CI: 2.678–12.886) and emergency cesarean section (OR = 11.965, 95%CI: 2.732–52.401) were independently associated with VTE in puerperium of women age 35 or older.

Conclusions

We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.
Can non-physician advanced retrieval practitioners (ARP) acquire and interpret diagnostic views of the lungs with sufficient quality to aid in the diagnosis of pneumothorax in the pre-hospital and retrieval environment?
Authors: Ronaldson James , Moultrie Christopher E. J. , Corfield Alasdair R. , McElhinney Evelyn
Published: October 2020

Background

As an adjunct to physical examination, ultrasound is a potentially attractive option for diagnosing pneumothoraces in the pre-hospital and retrieval environment – and could confer a benefit to patient safety. However, the published evidence supporting non-physicians use of ultrasound in this setting is limited.

Aim

We aimed to establish if Advanced Retrieval Practitioners (non-physicians) could acquire ultrasound views of the lungs and interpret them with sufficient quality to diagnose pneumothorax in the pre-hospital and retrieval environment when compared to expert review.

Method

The study consisted of an observational trial from April 2017 to April 2018. Twelve (12) patients bilateral lung ultrasound images (24 images) were randomly selected from 87 patients assessed using Point of Care Ultrasound (POCUS) by three Advanced Retrieval Practitioners in the Pre-hospital and Retrieval environment. Two expert reviewers’ evaluated these images to determine ARPs ability to acquire diagnostic quality images and interpret them correctly. CXR results of patients in whom lung ultrasound was undertaken were recorded as the reference standard investigation.

Results

Within the 22 images considered adequate by the Advanced Retrieval Practitioners, 19 (86.4%, one-tailed McNemar test p = 0.125) were considered adequate on expert review. Of the 19 images mutually considered as adequate, both the Advanced Retrieval Practitioners and the reviewers identified two pneumothoraces which were subsequently confirmed on chest x-ray (Sensitivity 100% and Specificity 100% in technically adequate images). One pneumothorax was detected on CXR in a patient with inadequate ultrasound images. Advanced Retrieval Practitioners were therefore able to both obtain adequate images and correctly diagnose pneumothorax in the pre-hospital environment with 66.6% sensitivity (95%CI 66.6–100%) and 100% specificity (95%CI 81.0–100%) compared to expert review.

Conclusion

Advanced Retrieval Practitioners (non-physicians) can obtain diagnostic views of the lungs of sufficient quality to diagnose the presence, or particularly the absence, of pneumothorax in the pre-hospital and retrieval environment. Although Advanced Retrieval Practitioners were less accurate than the expert reviewers at interpreting the quality of the ultrasound images, the result was not statistically significant, despite the ARPs possibly having been at a methodological disadvantage.