bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics of Kawasaki disease complicated with Mycoplasma pneumoniae pneumonia
Authors: Lan Yinle , Li Shuxian , Yang Dehua , Zhou Junfen , Wang Yingshuo , Wang Jianhua , Xu Yingchun , Chen Zhimin
Published: May 2020

This study aimed to investigate the inner linkage and mechanism of Mycoplasma pneumoniae (MP) infection and Kawasaki disease (KD), as well as the risk factors of outcome in this cohort of patients.

A retrospective study was performed in 210 patients diagnosed with KD complicated with community acquired pneumonia (CAP) in Children's Hospital, Zhejiang University School of Medicine from January 2014 to December 2017. They were divided into two groups based on MP infection: MP infection group (n = 97) and non-MP infection group (n = 113). We compared the variables of these two groups based on medical records.

The MP infection group had higher ESR than the non-MP infection group. During hospitalization, the non-MP infection group had higher levels of WBC during hospital, LDH, PCT, and lower HB when compared to the MP infection group. No differences were found in the hs-CRP level, N%, PLT, ALT, CKMB, and cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) between MP and non-MP infection group. Likewise, no difference was found in fever duration or hospital stays between them. Totally 19 patients in the infection group had CAA with a rate of 19.59%; and 27 (23.89%) patients had CAA in the non-MP infection group. Unfortunately, no difference was found in CAA rate between the two groups.

MP infection may occur simultaneously in children with Kawasaki disease. KD patients with MP infection tended to occur in older population. MP infection may not increase the risk of CAA, which still needs further large-scaled studies to confirm. Clinicians should be alert to KD patients with high level of ESR. MP should be screened and early treatment with macrolides should be given timely.
Loss of DNA mismatch repair proteins in prostate cancer
Authors: Sharma Meenal , Yang Zhiming , Miyamoto Hiroshi
Published: May 2020

Recent studies have suggested an increased risk of prostate cancer in men with Lynch syndrome driven by germline mutations in mismatch repair (MMR) genes. However, the incidence and clinical implication of MMR deficiency in sporadic prostate cancers remain poorly understood. We immunohistochemically stained for MLH1, MSH2, MSH6, and PMS2 in a set of tissue microarray consisting of 220 radical prostatectomy specimens and evaluated the relationship between loss of their expression and available clinicopathological features. MLH1, MSH2, MSH6, and PMS2 were lost in 2 (0.9%), 6 (2.7%), 37 (16.8%), and 27 (12.3%) prostate cancers, respectively. Loss of at least 1 MMR protein was identified in 50 (22.7%) cases. There were no statistically significant associations between MMR deficiency and patient age, family history of prostate cancer, Gleason score, or pT/pN stage. Nonetheless, the levels of preoperative prostate-specific antigen (PSA) were significantly (P = .015) higher in patients with MMR deficiency (mean ± SD: 9.12 ± 9.01 ng/mL) than in those without abnormal MMR (5.76 ± 3.17 ng/mL). There were 15 (6.8%) cases showing loss of at least 2 MMR proteins, which was not significantly associated with PSA level or tumor grade/stage. Additionally, 5 and 2 cases showed losses of at least 3 MMR proteins and all 4 proteins, respectively. Kaplan–Meier analysis revealed no significant associations between loss of MLH1 (P = .373), MSH2 (P = .348), MSH6 (P = .946), or PMS2 (P = .681), or at least 1 (P = .477), 2 (P = .486), or 3 (P = .352) MMR proteins and biochemical recurrence. Further analyses of the data on programmed death-ligand 1 (PD-L1) expression previously stained in the same set of tissue microarray demonstrated associations between loss of ≥2 MMR proteins and a higher rate of PD-L1 expression in cancer cells (17.2% vs 5.2%; P = .033) as well as between cases showing both loss of ≥1 MMR protein(s) and PD-L1 expression in tumor-infiltrating immune cells vs a higher risk of biochemical recurrence (P = .045). MMR protein loss was seen in a subset of prostate cancers. Interestingly, it was associated with significantly higher levels of PSA. Moreover, immunohistochemical detection of MMR proteins together with other proteins, such as PD-L1, might be helpful in predicting tumor recurrence following radical prostatectomy.
Development of an application for management of drug holidays in perioperative periods
Authors: Kimura Sakiko , Emoto Akiko , Yoshimura Mariko , Arimizu Kota , Kamura Tomoko , Sogawa Rintaro , Mizuta Kikumi , Tagomori Yasuhiro , Natsuaki Masahiro , Kajiwara Masataka , Tsuruoka Nanae , Yakushiji Yusuke , Tanigawa Yoshinori , Takamatsu Chihiro , Danjo Atsushi , Kamohara Keiji , Hirakawa Naomi , Sakaguchi Yoshiro , Noguchi Mitsuru , Noshiro Hirokazu , Kawaguchi Atsushi , Sueoka Eisaburo , Narisawa Yutaka , Kimura Shinya
Published: May 2020

Before surgery and other invasive treatments, decisions must be made on whether to discontinue drugs and provide appropriate drug holidays especially for antithrombotic drugs, and this is made difficult by the large number of available drugs and associated guidelines. We have therefore developed an online application for perioperative drug discontinuation and resumption management, named Saga Application for Management of Drug Holidays in PeriOperative Periods (SAMPOP).

Multidisciplinary medical staff at Saga University Hospital (SUH) worked together to build an evidence-based Perioperative Drug Discontinuation Management Database (PDDMD) and developed the user-friendly SAMPOP online application via preliminary verification at SUH. From September 2018 to February 2020, 420 medical staff at SUH, including physicians, nurses, and pharmacists, installed and tested SAMPOP.

Rate per surgical procedure for forgetting to discontinue antithrombotic drugs preoperatively decreased from 0.18% to 0.09% as of August 2019, 12 months after the introduction of SAMPOP (P = .1359). In addition, six months later, it decreased further to 0.03% as of February 2020 (P = .0436). Forgetting to resume antithrombotic drugs postoperatively decreased from 0.20% to 0.02% as of August 2019, 12 months after the introduction of SAMPOP (P = .0008). There was no case of forgetting to resume the medication in the last 6 months.

SAMPOP may be useful for management of drug holidays in the clinic and warrants further evaluation of its safety and efficacy.
Vitamin D supplementation for nonalcoholic fatty liver disease in type 2 diabetes mellitus
Authors: Wang Shengju , Cai Baochao , Han Xuke , Gao Yang , Zhang Xiaoran , Wang Ruili , Zhang Yuan , Chen Qiu
Published: May 2020

Background:

Nonalcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes mellitus (T2DM), and low vitamin D levels are positively associated with NAFLD and T2DM. But there is absence of convincing evidence-based medicine to confirm the efficacy of vitamin D supplementation for T2DM with NAFLD. Thus, we aimed to conduct this meta-analysis to summarize the efficacy of vitamin D supplementation for T2DM combined with NAFLD, and help to further clarify its beneficial action on diabetic patients with NAFLD.

Methods:

The study only selects clinical randomized controlled trials of vitamin D supplementation for T2DM combined with NAFLD. We will search each database from the built-in until July 2020. The English literature mainly searches Cochrane Library, Pubmed, EMBASE, and Web of Science. While the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Meanwhile, we will retrieve clinical trial registries and grey literature. Two researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is represented by relative risk (RR), and the continuous is expressed by mean difference (MD) or standard mean difference (SMD), eventually the data is synthesized using a fixed effect model (FEM) or a random effect model (REM) depending on the heterogeneity. The imaging markers of liver, biomarkers of hepatic steatosis, serological indexes of hepatic fibrosis, serum NAFLD liver fat score were evaluated as the main outcomes. While several secondary outcomes were also evaluated in this study. The statistical analysis of this meta-analysis was conducted by RevMan software version 5.3.

Results:

This meta-analysis will further determine the beneficial efficacy of vitamin D supplementation for T2DM combined with NAFLD.

Conclusion:

This study determines the positive efficacy of vitamin D supplementation for diabetic patients with NAFLD.
Rapid platelet count improvement in chronic hepatitis C patients with thrombocytopenia receiving direct-acting antiviral agents
Authors: Chen Yen-Chun , Tseng Chih-Wei , Tseng Kuo-Chih
Published: May 2020

The effect of direct-acting antiviral agents (DAAs) on short-term platelet improvement in chronic hepatitis C (CHC) patients with thrombocytopenia is unclear.

From December 2015 to March 2018, a total of 249 CHC patients receiving DAA treatment with baseline thrombocytopenia (platelet count <150 × 103 /μL) at Dalin Tzu Chi Hospital were enrolled in this retrospective study. Blood examinations were conducted at baseline (BL), week 4 (W4) after DAA initiation, end of treatment (EOT), and 12 weeks after EOT (P12).

Hepatitis C virus (HCV) genotyping revealed that 184 patients (73.9%) carried HCV genotype 1. Of the patients in the cohort, 87 (34.9%) were interferon (IFN)-experienced, and 213 (85.5%) had advanced fibrosis. All but 1 patient achieved SVR12 (sustained virologic response (SVR) rate, 99.6%; 248/249). The platelet count recovered significantly in 104 patients (41.7%; 104/249). The mean baseline platelet count was 102 × 103/μL before DAA, increasing to 116 × 103/μL, 114 × 103/μL, and 113 × 103/μL at W4, EOT, and P12, respectively. Comparison of the mean platelet count at baseline with that at W4, EOT, and P 12 showed statistically significant increases at all time points (W4 vs BL, P < .001; EOT vs BL, P < .001; P12 vs BL, P < .001). Multivariate analyses revealed moderate or severe fatty liver (P = .024) and lower baseline platelet count (P = .005) was significantly associated with platelet count improvement.

In conclusion, thrombocytopenia associated with CHC rapidly improves with the administration of DAA. Moderate or severe fatty liver and lower baseline platelet count predict significant improvement of platelet count.
Risk of venous thromboembolism, use of enoxaparin and clinical outcomes in obese patients undergoing laparoscopic adjustable gastric band surgery
Authors: Hussain Zahid , Peterson Gregory M. , Mirkazemi Corinne , Curtain Colin , Zaidi Syed Tabish R.
Published: May 2020

There is a lack of clear guidance for the prophylactic use of anticoagulants for patients undergoing laparoscopic adjustable gastric banding (LAGB) surgery.

This study aimed to evaluate the risk of venous thromboembolism (VTE), prophylactic use of enoxaparin and clinical outcomes in patients undergoing primary and revisional LAGB procedures.

A retrospective study evaluated the prophylactic use of enoxaparin in adult patients who underwent primary and revisional (band and port) LAGB procedures. The incidence of VTE and major bleeding was investigated during a 90-day follow-up period. Descriptive and inferential statistics were used for data analysis.

We included 112 and 100 patients who had undergone primary and revisional (24 band procedures and 76 port procedures) LAGB surgery, respectively. The majority of patients (97%) had a mild risk of VTE development using a post-discharge VTE risk calculator tool published from the Cleveland Clinic. All primary procedure patients received prophylactic enoxaparin, compared to 79% and 20% of revisional patients who underwent band and port procedures, respectively (P < .001). The overall VTE incidence was 0.9%, with no significant difference between patients who did or did not receive chemoprophylaxis (0.7% and 1.5%, respectively; P = .58). No major bleeding events were observed.

Chemoprophylaxis may not be required in all patients undergoing low-risk LAGB surgery unless there are additional risk factors, such as the presence of super-super-morbid obesity or concomitant hormone replacement therapy. More studies are needed on the prophylactic use and dosing of enoxaparin in patients undergoing LAGB procedures to provide high-level evidence.
Does concomitant methotrexate confer clinical benefits in patients treated with prior biologic therapy? Analysis of data from a noninterventional study of rheumatoid arthritis patients initiating treatment with adalimumab
Authors: Schmalzing Marc , Behrens Frank , Schwaneck Eva C. , Koehm Michaela , Greger Gerd , Gnann Holger , Burkhardt Harald , Tony Hans-Peter
Published: May 2020

Most studies of methotrexate (MTX) in combination with tumor necrosis factor (TNF) inhibitors have focused on treatment-naive patients with early disease. The goal of this study was to evaluate whether previous biologic therapy influenced the impact of concomitant MTX in patients initiating treatment with adalimumab.

We retrospectively analyzed data from 2 large noninterventional studies of German patients with active rheumatoid arthritis (RA) who initiated adalimumab therapy during routine clinical practice. Patients were seen between April 2004 and February 2013 for study 1 and between April 2003 and March 2013 for study 2. Key outcomes were Disease Activity Score-28 joints (DAS28), patient global assessment of health (PGA), and pain. Subgroup analyses by prior biologic treatment were performed on patients treated with continuous adalimumab monotherapy or adalimumab plus MTX for 12 months and 2-sample t tests were used to evaluate differences. We also assessed outcomes in subgroups in which MTX had been added or removed at 6 months and compared outcomes with 1-sample t tests.

Of 2654 patients, 1911 (72%) were biologic naive and 743 (28%) had received prior biologic therapy, usually with a TNF inhibitor. All subgroups showed improvements following initiation of adalimumab therapy. In patients with no previous biologic treatment, continuous adalimumab plus MTX was associated with greater improvements in DAS28, PGA, and pain at month 12 compared with continuous adalimumab monotherapy (P = .0006, .0031, and .0032, respectively). In patients with previous biologic treatment, concomitant MTX was associated with statistically significant benefits in pain only. Adding MTX at month 6 resulted in additional benefits in patients with no prior biologic therapy, but not those with previous biologics.

We conclude that concomitant MTX resulted in additional improvements in DAS28 and PGA vs adalimumab monotherapy in patients with no previous biologic therapy, but changes were not statistically significant in patients treated with prior biologics. These findings may help inform the patient/provider treatment decision during routine clinical care.
Mindfulness-Based Interventions for Young People With Cancer
Authors: Pathrose Sheeja Perumbil , Everett Bronwyn , Patterson Pandora , Ussher Jane , Salamonson Yenna , McDonald Fiona , Biegel Gina , Ramjan Lucie
Published: May 2020

Background

Mindfulness-based interventions (MBIs) have demonstrated benefits for adults with chronic illness and are becoming increasingly popular among children and young people. Mindfulness-based interventions could have benefits for young people with cancer throughout the treatment journey, through to survivorship.

Objective

The aim was to review intervention studies about MBI used with young people with cancer between the ages of 10 and 29 years.

Methods

Six electronic databases were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools.

Results

Six contemporary studies met the inclusion criteria. Three studies adapted MBI to be age appropriate and some studies modified the intervention based on cancer-specific needs of young people. Formal and informal MBI activities were found to be acceptable by young people; however, recruitment of the participants was identified as a barrier. Variability in psychosocial outcomes was noted in the review by some demonstrating improvement in areas such as mindfulness, anxiety, and social isolation and others not eliciting significant benefits.

Conclusions

Mindfulness-based intervention shows promise as an acceptable intervention that may improve psychosocial well-being for young people with cancer. Future research studies with adequate sample sizes are warranted to determine the effectiveness of MBI among young people with cancer.

Implications for Practice

Mindfulness-based intervention seems to be a promising approach to promote psychosocial well-being and reduce disease burden in young people with cancer. As validated MBI may be implemented without expert training, this could be promoted by healthcare providers, including nurses who care for young people with cancer.
The Use of Mobile Applications for Managing Care Processes During Chemotherapy Treatments: A Systematic Review
Authors: Magalhães Bruno , Fernandes Carla , Santos Célia , Martínez-Galiano Juan Miguel
Published: May 2020

Background

The recent mobile technology advancements, such as the development of applications (apps) for mobile phones and tablets, can assist in the development of low-cost platforms to monitor therapeutic adherence or complications, providing easily accessible information or guidelines in self-care focused on the care recipient.

Objective

The aim of this study was to gather scientific evidence about the efficacy of the use of mobile apps during chemotherapy treatments.

Methods

A systematic review of quantitative studies was performed. All articles published until May 31, 2019 were identified in databases MEDLINE, CINAHL Psychology and Behavioral Sciences Collection, and Cochrane Library.

Results

A total of 10 quantitative studies were included. A set of metrics was identified that essentially analyze issues related to the devices’ functionalities. The metrics associated with engagement and related to behavioral dimensions, associated with the use of/adherence to the mobile app, are predominant. The clinical metrics represent 25 of a total of 53 identified metrics. Beneficial and statistically significant results were identified related to fatigue, self-efficacy, and improvements in reports of complications.

Conclusion

Based on the available research, mobile apps are likely to be a useful and acceptable tool to monitor interventions and complications. In addition, mobile apps can help in the self-management of treatment-related complications. Importantly, these apps need to bridge the academic context and clinical practice, by evaluating the impact of the use of mobile apps in patients.

Implications for Practice

The concept of prescribing apps is being addressed to ensure that apps work and have fair privacy and data security policies that address safety requirements.
Distinct Aspects of Decision Making in Obsessive-Compulsive Disorder
Authors: Noroozian Maryam , Sharifi Vandad , Alaghband-rad Javad , Motamed Mahtab
Published: May 2020

Individuals with obsessive-compulsive disorder (OCD) rely on “explicit learning” strategies in decision making. It is suggested that periods of brief distraction (in healthy individuals) result in better decisions in complex situations. It can be hypothesized that periods of unconscious thought would not lead to better decisions due to impairment of implicit learning in OCD. A total of 121 OCD patients and 120 healthy participants were presented with a task in which they had to choose between four apartments with multiple attributes. Participants were randomly assigned to one of three conditions: making a decision immediately after being presented with options (immediate), after thinking carefully for 2 minutes (conscious thought [CT]), or after being distracted for 2 minutes (unconscious thought [UT]). Individuals with OCD performed worse than healthy controls in UT condition, although they did better in CT condition. Our study supports the idea of dysfunction in implicit processing and overreliance on explicit processes in OCD.
PD-L1 Expression and CD8+ Tumor-infiltrating Lymphocytes in Different Types of Tubo-ovarian Carcinoma and Their Prognostic Value in High-grade Serous Carcinoma
Authors: Chen Hao , Molberg Kyle , Strickland Amanda L. , Castrillon Diego H. , Carrick Kelley , Jiang Qingping , Niu Shuang , Rivera-Colon Glorimar , Gwin Katja , Hinson Stacy , Lea Jayanthi , Miller David S. , Zheng Wenxin , Lucas Elena
Published: May 2020

The prevalence and significance of programmed death-1 ligand (PD-L1) expression in different types of tubo-ovarian carcinoma have not been well defined. We evaluated PD-L1 expression and CD8+ tumor-infiltrating lymphocyte (TIL) density in whole tissue sections of 189 cases of tubo-ovarian carcinoma, including high-grade serous carcinoma (HGSC, n=100), clear cell carcinoma (CCC, n=24), endometrioid carcinoma (EmC, n=40), and mucinous carcinomas (MC, n=25). Using the tumor proportion score (TPS) with a 1% cutoff, PD-L1 expression was present in 21% of HGSC, 16.7% of CCC, 2.5% of EmC, and 4% of MC. Using the combined positive score (CPS) with a cutoff of 1, PD-L1 expression was present in 48% of HGSC, 25% of CCC, 20% of EmC, and 24% of MC. HGSC demonstrated significantly higher CD8+ TIL density than CCC (P=0.013238), EmC (P=0.01341), or MC (P=0.004556). In HGSC, CD8+ TIL density was directly correlated with PD-L1 positivity using either TPS (P=0.0008) or CPS (P=0.00011). Survival analysis of patients with high stage (stage III to IV) HGSC revealed PD-L1 positivity by TPS to be associated with improved progression-free survival (adjusted hazard ratio: 0.4912 vs. 2.036, P=0.0378). Although not statistically significant, a similar trend was observed in overall survival (adjusted hazard ratio: 0.3387 vs. 2.953, P=0.0548). In contrast, with CPS, no significant difference was identified between PD-L1-positive and negative groups in either progression-free survival (P=0.5086) or overall survival (P=0.7823). Neoadjuvant chemotherapy was associated with higher PD-L1 expression by TPS (P=0.00407) but not CPS. No significant difference in PD-L1 expression was detected in tumors from patients with germline BRCA1/2 mutations compared with germline mutation-negative tumors by either TPS or CPS. In conclusion, the prevalence of PD-L1 expression is variable in different types of tubo-ovarian carcinoma and is highest in HGSC. In high-stage HGSC, PD-L1 positivity in tumor cells is associated with an increased immune response and improved survival.
Severe Agitation in a Teenager With Spastic Cerebral Palsy
Authors: Greenky David , Khan Naghma S.
Published: May 2020

Neuroleptic malignant syndrome is a challenging diagnosis because it mimics many other conditions. We present a case of a 16-year-old boy with spastic cerebral palsy who presented with severe agitation, hyperthermia, and autonomic dysfunction. He arrived to a community pediatric hospital without a caregiver to provide a detailed history, which further complicated his management.
Trends in State Policy Support for Sexual Minorities and HIV-Related Outcomes Among Men Who Have Sex With Men in the United States, 2008–2014
Authors: Hatzenbuehler Mark L. , McKetta Sarah , Goldberg Naomi , Sheldon Alex , Friedman Samuel R. , Cooper Hannah L. F. , Beane Stephanie , Williams Leslie D. , Tempalski Barbara , Smith Justin C. , Ibragimov Umedjon , Mermin Jonathan , Stall Ron
Published: May 2020

Background:

To examine trends in state-level policy support for sexual minorities and HIV outcomes among men who have sex with men (MSM).

Methods:

This longitudinal analysis linked state-level policy support for sexual minorities [N = 94 metropolitan statistical areas (MSAs) in 38 states] to 7 years of data (2008–2014) from the Centers for Disease Control and Prevention on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (eg, nondiscrimination laws including sexual orientation as a protected class) from 1999 to 2014, deriving the following 3 latent groups: consistently low policy support, consistently high policy support, and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM, late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within 3 months of HIV diagnosis) per 10,000 MSM, AIDS diagnoses per 10,000 MSM with HIV, and AIDS-related mortality per 10,000 MSM with AIDS.

Results:

Compared with MSAs in states with low policy support and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses [risk difference (RD) = −37.9, 95% confidence interval (CI): −54.7 to −21.0], late diagnoses (RD = −12.5, 95% CI: −20.4 to −4.7), and AIDS-related mortality (RD = −33.7, 95% CI: −61.2 to −6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to the policy climate.

Conclusion:

The state-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.
A Novel Injection Technique for Extended-Release Local Anesthetic After Posterior Colporrhaphy and Perineorrhaphy: A Randomized Controlled Study
Authors: Evans Sarah Keenan Larkin , Abimbola Obafunbi , Myers Erinn M. , Tarr Megan E.
Published: May 2020

Objectives

To evaluate the effect of vaginal intraoperative infiltration of liposomal bupivacaine on vaginal pain among patients undergoing posterior colporrhaphy and perineorrhaphy.

Methods

This was a randomized, placebo-controlled trial offered to women undergoing posterior colporrhaphy and perineorrhaphy with concomitant pelvic reconstructive procedures. Liposomal bupivacaine or normal saline placebo (30 mL) was injected into the posterior vaginal compartment and perineal body in 2- to 3-mL increments, using a systematic technique. All participants received 10-mL 0.25% bupivacaine with epinephrine prior to incision. Perioperative care was standardized. The primary outcome was vaginal pain as measured by a visual analog scale.

Results

One hundred twenty-six women were screened, and 72 were included. Demographic characteristics were similar. Median visual analog scale was not different at any time point (P = 0.81). There were no differences in secondary outcomes, including narcotic use (37.5 vs 37.5 mg morphine equivalents, P = 0.51; placebo vs liposomal bupivacaine), time to first opioid (68 vs 89.5 minutes, P = 0.56), antiemetic doses (3 vs 2, P = 0.07), hospital length of stay (24 vs 21.9 hours, P = 0.98), length of stay in postanesthesia care unit (93 vs 100 minutes, P = 0.32), proportion of patients who had a bowel movement within the first 3 postoperative days (65.7 vs 59.5% P = 0.36), or successful voiding trials (45.7 vs 59.5%, P = 0.24). There were no differences in patient satisfaction or postoperative adverse events.

Conclusions

In this study of pelvic reconstructive surgeries with posterior colporrhaphy and perineorrhaphy, there were no differences in pain scores or any secondary outcomes between liposomal bupivacaine and placebo injected into the posterior vaginal compartment.
Comparison of Methods to Identify Stress Urinary Incontinence in Women With Pelvic Organ Prolapse
Authors: Martin Laura , Ossin David , Schachar Jeffrey , Devakumar Hemikaa , Alas Alexandriah , Davila G. Willy , Reis Isildinha M. , Miao Feng , Hurtado Eric
Published: May 2020

Objective

The aim of the study was to compare which test is most sensitive in identifying stress urinary incontinence (SUI) in women with pelvic organ prolapse using urodynamics (UDS) as the criterion standard: cough stress test (CST) or pyridium pad test.

Methods

This was a prospective study of women with pelvic organ prolapse stage II or greater who desired surgical management for prolapse. Each patient underwent preoperative urinary testing: UDS, CST, and a 24-hour pyridium pad test.

Results

A total of 84 patients were analyzed. Using UDS as the criterion standard, both the CST and the pyridium pad test showed a fair agreement with UDS outcomes (κ = 0.27 for both tests). There was no statistically significant difference between the CST and pyridium pad test, with estimated sensitivities of 34.4% versus 60.6% (P = 0.791) and specificities of 90.4% versus 84.6% (P = 0.508). The pyridium pad test was found to have a statistically significant difference in identifying the subjective complaint of SUI (38.6%, P = 0.003) compared with other tests. Patients with occult incontinence were identified 42.5%, 17.5%, and 10% of the time during UDS, CST, and pyridium pad testing, respectively.

Conclusion

Our data suggest that the sensitivities of the CST and pyridium pad test for stress incontinence and occult stress incontinence in patients with pelvic organ prolapse are low when compared with UDS as the criterion standard. Urodynamics has an important role in preoperative identification of occult SUI.
Successful Treatment With Lithium in a Refractory Patient With Periodic Catatonic Features: A Case Report
Authors: Sato Yoshiteru , Shinozaki Masataka , Okayasu Hiroaki , Yasui-Furukori Norio , Shimoda Kazutaka
Published: May 2020

Background

Catatonia is a severe condition in patients. Electroconvulsive treatment or medication with benzodiazepines and/or antipsychotics are regarded as standard treatment.

Case Presentation

We report a case of a patient with catatonic features in whom electroconvulsive treatment and benzodiazepine and/or antipsychotic medications failed to achieve efficacy. Additional treatment with lithium ameliorated catatonia.

Conclusion

We concluded that lithium is an optional treatment in patients in whom standard treatment failed.
Vitamin C for the treatment of COVID-19: A living systematic review
Authors: Baladia Eduard , Pizarro Ana Beatriz , Rada Gabriel
Published: May 2020

Objective

This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of vitamin C in the treatment of patients with COVID-19.

Data sources

We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.

Eligibility criteria for selecting studies and methods

We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question.

We will include randomised trials evaluating the effect of vitamin C, as monotherapy or in combination with other drugs, versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating vitamin C in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case no direct evidence from randomised trials is found, or if the direct evidence provides low- or very low-certainty for critical outcomes.

Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome.

A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.

Ethics and dissemination

No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

PROSPERO Registration

Submitted to PROSPERO (awaiting ID allocation).
Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis
Authors: Ren Lu , Xu Wilson , Overton James L , Yu Shandong , Chiamvimonvat Nipavan , Thai Phung N.
Published: May 2020

Background

Recently, chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have emerged as potential antiviral and immunomodulatory options for the treatment of 2019 coronavirus disease (COVID-19). To examine the safety profiles of these medications, we systematically evaluated the adverse events (AEs) of these medications from published randomized controlled trials (RCTs).

Methods

We systematically searched PubMed, MEDLINE, Cochrane, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the ClinicalTrials.gov for all the RCTs comparing CQ or HCQ with placebo or other active agents, published before March 31, 2020. The random-effects or fixed-effects models were used to pool the risk estimates relative ratio (RR) with 95% confidence interval (CI) for the outcomes.

Results

The literature search yielded 23 and 17 studies for CQ and HCQ, respectively, that satisfied our inclusion criteria. Of these studies, we performed meta-analysis on the ones that were placebo-controlled, which included 6 studies for CQ and 14 studies for HCQ. We did not limit our analysis to published reports involving viral treatment alone; data also included the usage of either CQ or HCQ for the treatment of other diseases. The trials for the CQ consisted of a total of 2,137 participants (n=1,077 CQ, n=1,060 placebo), while the trials for HCQ involved 1,096 participants (n=558 HCQ and n=538 placebo). The overall mild or total AEs were statistically higher comparing CQ or HCQ to placebo. The AEs were further categorized into four groups and analyses revealed that neurologic, gastrointestinal, dermatologic, and ophthalmic AEs were higher in participants taking CQ compared to placebo. Although this was not evident in HCQ treated groups, further analyses suggested that there were more AEs attributed to other organ system that were not included in the categorized meta-analyses. Additionally, meta-regression analyses revealed that total AEs was affected by dosage for the CQ group.

Conclusions

Taken together, we found that participants taking either CQ or HCQ have more AEs than participants taking placebo. Precautionary measures should be taken when using these drugs to treat COVID-19.
Rapid generation of neutralizing antibody responses in COVID-19 patients
Authors: Suthar Mehul S , Zimmerman Matthew , Kauffman Robert , Mantus Grace , Linderman Susanne , Vanderheiden Abigail , Nyhoff Lindsay , Davis Carl , Adekunle Seyi , Affer Maurizio , Sherman Melanie , Reynolds Stacian , Verkerke Hans , Alter David N , Guarner Jeannette , Bryksin Janetta , Horwath Michael , Arthur Connie , Saakadze Natia , Smith Geoffrey Hughes , Edupuganti Srilatha , Scherer Erin M , Hellmeister Kieffer , Cheng Andrew , Morales Juliet A , Neish Andrew S , Stowell Sean R , Frank Filipp , Ortlund Eric , Anderson Evan , Menachery Vineet , Rouphael Nadine , Metha Aneesh , Stephens David S , Ahmed Rafi , Roback John , Wrammert Jens
Published: May 2020

SARS-CoV-2 is currently causing a devastating pandemic and there is a pressing need to understand the dynamics, specificity, and neutralizing potency of the humoral immune response during acute infection. Herein, we report the dynamics of antibody responses to the receptor-binding domain (RBD) of the spike protein and virus neutralization activity in 44 COVID-19 patients. RBD-specific IgG responses were detectable in all patients 6 days after PCR confirmation. Using a clinical isolate of SARS-CoV-2, neutralizing antibody titers were also detectable in all patients 6 days after PCR confirmation. The magnitude of RBD-specific IgG binding titers correlated strongly with viral neutralization. In a clinical setting, the initial analysis of the dynamics of RBD-specific IgG titers was corroborated in a larger cohort of PCR-confirmed patients (n=231). These findings have important implications for our understanding of protective immunity against SARS-CoV-2, the use of immune plasma as a therapy, and the development of much-needed vaccines.
Quantifying the social distancing privilege gap: a longitudinal study of smartphone movement
Authors: Dasgupta Nabarun , Funk Michele Jonsson , Lazard Allison , White Benjamin Eugene , Marshall Stephen W.
Published: May 2020

Background

In response to the coronavirus pandemic, social distancing became a widely deployed countermeasure in March 2020. We examined whether healthier and wealthier places more successfully implemented social distancing.

Methods

Mobile device location data were used to quantify declines in movement by county (n=2,633) in the United States of America, comparing April 15–17 (n=65,544,268 traces) to baseline of February 17 - March 7. Negative binomial regression was used to estimate gradients of privilege across eleven healthcare and economic indicators, adjusting for rurality and stay-at-home mandates. External validation used separate venue-specific data from Google Location Services.

Findings

Counties without stay-at-home orders showed a mobility decline of −52·3% (95% CI: −50·3%, −54·3%), slightly less than the decline in mandated areas (−60·8%; 95% CI: −60·0%, −61·6%). Strong linear gradients in privilege were observed. After adjusting for rurality and stay-at-home orders, counties in the highest quintile of social distancing mobility restriction had: 52% less uninsured, 47% more primary care providers, 29% more exercise space, 27% less food insecurity, 26% less child poverty, 17% higher incomes, 14% less overcrowding, 9·6% more racial segregation, 8·2% less youth, 7·4% more elderly, and 6·2% less influenza vaccination, compared to least social distancing areas.

Interpretation

Healthier and wealthier counties displayed a social distancing privilege gap, measured via smartphone mobility change. Structural inequities in this key countermeasure will influence immunity, and disease incidence and mortality.

Funding

None
Linear regression analysis of COVID-19 outbreak and control in Henan province caused by the output population from Wuhan
Authors: Yuan yuan Cheng
Published: May 2020

Objectives

To observe outbreak of COVID-19 in Henan province caused by the output population from Wuhan, and high-grade control measures were proformed in Henan province, to study the phase of development and change of the epidemic in Henan province, and to make appropriate inferences about the influence of prevention and control measures and the phase of development of the epidemic.

Methods

Linear regression analysis were used to establish a linear regression model with the number of Wuhan roaming people as the dependent variable and the cumulative number of COVID-19 cases in Henan province as the dependent variable, and to calculate and plot the regional distribution of the number of cases in 18 cities in Henan province in accordance with the criteria of whether the number of cases exceeded the expected number.

Results

There was a linear correlation between the number of people Wuhan roaming and the number of cases, and the linear regression model equation was statistically significant. The cities that exceeded the expected number of cases had a clear spatio-temporal distribution. Geographically, these cities were roughly in the 1 o’clock and 2 o’clock directions in Nanyang, and in terms of time period, the first phase (10 days), the cities that exceeded the expected number of cases changed almost daily. In the second phase (5 days), cities that exceeded the expected number of cases were moderated, and in the third phase (15 days), cities that exceeded the expected number of cases entered the stabilization phase.

Conclusions

The priority cities for COVID-19 prevention and control in Henan province should pay special attention to the cities that have exceeded the expected number of COVID-19 cases, and the implementation of high-level control measures can effectively control the spread of COVID-19 within 2-4 weeks during the early stage of the epidemic.
Suppressing the impact of the COVID-19 pandemic using controlled testing and isolation
Authors: Cohen Kobi , Leshem Amir
Published: May 2020

The Corona virus disease 2019 (COVID-19) has significantly affected lives of people around the world. Today, isolation policy is enforced by identifying infected individuals based on symptoms when these appear or by testing people and quarantining those who have been in close contact with infected people. In addition, many countries have imposed complete or partial lock-downs to control the spread of the disease. While this has resulted in some some success in slowing down the spread of the virus, lock-downs as well as widespread quarantine have devastating effects on the economy and social life. Thus, governments are urgently looking for efficient strategies to significantly relax lock-downs, while still controlling the spread of the virus. We argue that this can be done by using active feedback to control testing for infection by actively testing individuals with a high probability of being infected. We develop an active testing strategy to achieve this goal, and demonstrate that it would have tremendous success in controlling the spread of the virus on one million people, using 3,000 tests per day. Our results show up to a 50% reduction in quarantine rate and morbidity rate in typical settings as compared to existing methods.
Who maintains a good mental health in a locked-down country? A French nationwide online survey of 11,391 participants
Authors: Haesebaert Frédéric , Haesebaert Julie , Zante Elodie , Franck Nicolas
Published: May 2020

Background

Lockdown measures induce massive societal perturbations and can differentially affect mental wellbeing in populations depending on individual determinants. We aim at investigating the sociodemographic and environmental determinants of wellbeing during global lockdown due to the SARS-CoV-2 pandemic.

Methods

A nationwide survey was sent online to the French population during the second week of global lockdown during the SARS-CoV-2 pandemic, between March 25, 2020 and March 30, 2020. Volunteers were recruited on social networks, online newspapers, and mailing lists. We analyzed sociodemographic and environmental variables obtained from a co-built and evidence-based questionnaire. Mental wellbeing was measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS).

Results

We analyzed data from 11,391 (56.6%) out of 20,235 participants who answered the questionnaire. After weighting data on age and gender distributions, 5415 of the respondents were male (47.5%), 5932 were female (52.1%), and 52 (0.5%) registered as “other.” Multivariate analyses indicated that various factors impacted mental wellbeing. Being female (p < .001), a student (p < .001), disabled (p = .001), or having no access to outdoor space (p = 0.02) was associated with lower WEMWBS scores. Conversely, being employed (p < .001) and having more social contacts (p < .01) were both associated with greater mental wellbeing.

Interpretation

We revealed differences in mental wellbeing among the French population at the early stages of global lockdown. Authorities should consider the particular vulnerability of students, persons with disabilities, and those living in constrained housing conditions that could increase the negative impact of lockdown on mental health.
The impact of strict public health measures on COVID-19 transmission in developing countries: The case of Kuwait
Authors: Al-Shammari Abdullah A. , Ali Hamad , Alahmad Barrak , Al-Refaei Faisal H. , Al-Sabah Salman , Jamal Mohammad H. , Alshukry Abdullah , Al-Duwairi Qais , Al-Mulla Fahd
Published: May 2020

Background

Many countries have succeeded in curbing the outbreak of COVID-19 by employing strict public health control measures. However, little is known about the effectiveness of such control measures in curbing the outbreak in developing countries. In this study, we seek to assess the impact of various outbreak control measures in Kuwait to gain more insight into the outbreak progression and the associated healthcare burden.

Methods

We use a SEIR mathematical model to simulate the epidemic outbreak of COVID-19 in Kuwait with additional testing and hospitalization compartments. We use a NBD observational framework for confirmed case and death counts. We forecast model trajectories and assess the effectiveness of public health interventions by using maximum likelihood to estimate both the basic and effective reproduction numbers.

Results

Our results indicate that the early strict control measures had the effect of delaying the intensity of the outbreak but were unsuccessful in reducing the effective reproduction number below 1. Forecasted model trajectories suggest a need to expand the healthcare system capacity to cope with the associated epidemic burden of such ineffectiveness.

Conclusion

Strict public health interventions may not always lead to the same desired outcomes, particularly when population and demographic factors are not accounted for as in the case in some developing countries. Real-time dynamic modeling can provide an early assessment of the impact of such control measures as well as a forecasting tool to support outbreak surveillance and the associated healthcare expansion planning.

SUMMARY BOX

What is already known on the subject?

Evidence is accumulating about the positive impact of various strict public health interventions on the transmission of COVID-19 in the developed world. Currently, however, many developing countries are still struggling to control and suppress the initial wave of the outbreak. In particular, less attention is given to assessing the impact of taking similar strict control measures.

What does this study add?

Our modeling study provides the first evidence showing how the imposition of strict public health measures has not led to a reduction in COVID-19 transmission in Kuwait. It highlights the importance of performing systematic epidemiological and public health investigations of the population factors which may limit the effectiveness of standard public health interventions in developing countries. It also emphasizes the utility of adopting dynamic modeling approaches for intervention assessment and healthcare capacity re-adjustment at the earliest stages of the outbreak.