bluuebunny/crossref_metadata_2025 huggingface dataset:
Silencing long non‐coding RNA DLX6‐AS1 or restoring microRNA‐193b‐3p enhances thyroid carcinoma cell autophagy and apoptosis via depressing HOXA1
Authors: Feng Ling , Wang Ru , Wang Yifan , Shen Xixi , Shi Qian , Lian Meng , Ma Hongzhi , Fang Jugao
Published: September 2021

Long non‐coding RNA DLX6 antisense RNA 1 (DLX6‐AS1) lists a critical position in thyroid carcinoma (TC) development. However, the overall comprehension about DLX6‐AS1, microRNA (miR)‐193b‐3p and homeobox A1 (HOXA1) in TC is not thoroughly enough. Concerning to this, this work is pivoted on DLX6‐AS1/miR‐193b‐3p/HOXA1 axis in TC cell growth and autophagy. TC tissues and adjacent normal thyroid tissues were collected, in which expression of DLX6‐AS1, miR‐193b‐3p and HOXA1 was tested, together with their interactions. TC cells were transfected with DLX6‐AS1/miR‐193b‐3p‐related oligonucleotides or plasmids to test cell growth and autophagy. Tumorigenesis in nude mice was observed. DLX6‐AS1 and HOXA1 were up‐regulated, and miR‐193b‐3p was down‐regulated in TC. Depleted DLX6‐AS1 or restored miR‐193b‐3p disturbed cell growth and promoted autophagy. DLX6‐AS1 targeted miR‐193b‐3p and positively regulated HOXA1. miR‐193b‐3p inhibition mitigated the impaired tumorigenesis induced by down‐regulated DLX6‐AS1. Tumorigenesis in nude mice was consistent with that in cells. It is clear that DLX6‐AS1 depletion hinders TC cell growth and promotes autophagy via up‐regulating miR‐193b‐3p and down‐regulating HOXA1.
Ideology, Disadvantage, and Federal District Court Inmate Civil Rights Filings: The Troubling Effects of Pro Se Status
Authors: Gunderson Anna
Published: September 2021

Nearly 80 percent of all federal judicial activity occurs in the district courts and a significant portion of that activity is the result of prisoners filing petitions against state and federal correctional representatives. We know relatively little about these lawsuits, however. This article focuses on inmate civil rights filings as a vital form of political action of those incarcerated and argues that ideology and disadvantage play a role in the ultimate outcome of these cases. I amass a large dataset of every prison condition or civil rights petition filed by an inmate from 1989 to 2016 and find that while ideology does not predict the likelihood an inmate lawsuit will succeed, that prisoners' pro se status, whether they file the petition without the aid of an attorney, makes it significantly more likely the suit will be dismissed and less likely that inmate will receive relief. This is suggestive evidence that pro se status, and not necessarily actual legal quality, may be driving outcomes in prisoners' rights cases. This article has implications not only for the study of judicial decision making in the federal district courts, but also as an example of important political action of a disenfranchised and neglected group in our legal system.
Quantum dots‐based fluorescence immunoassay for detection of tiamulin in pork
Authors: Zhou Jingming , Zhang Xiaoli , Qian Wenjing , Yang Qingbao , Qi Yanhua , Chen Yumei , Wang Aiping
Published: September 2021

Tiamulin (TML) is a kind of diterpenoid veterinary antibiotic. If abused, it will cause residues in edible tissues of animals and endanger human health. Thus, a facile, sensitive, and accurate method is essential for TML detection. In this study, TML complete antigen was synthesized by oximation and active ester method, and monoclonal antibodies with high specificity and sensitivity were prepared. ZnCdSe/ZnS quantum dots (QDs) coupled with goat anti‐mouse IgG were used as a fluorescence detection probe to establish indirect competitive fluorescent immunosorbent assay (icFLISA) for the determination of TML in pork. The 50% inhibitory concentration (IC50) of the icFLISA was 0.069 ng/ml, and the limits of detection (LOD) were 0.309 pg/ml. The recovery of the spiked pork samples for the icFLISA ranged from 85.6 to 96.8%, and the coefficient of variation (CV) was less than 9.4%. The results showed that the icFLISA based on ZnCdSe/ZnS QDs was more sensitive than the traditional indirect competitive enzyme‐linked immunosorbent assay for the detection of TML in edible animal tissues.
Nurses' experiences of using restraint in neurosurgical care – A qualitative interview study
Authors: Guenna Holmgren Amina , Juth Niklas , Lindblad Anna , von Vogelsang Ann‐Christin
Published: September 2021

Aim and objectives

To describe nurses' experiences of using restraint in neurosurgical care.

Background

Despite reports of negative consequences, and conflicts with key values in healthcare, restraint measures are still practised in somatic healthcare worldwide. When using restraint, basic principles of nursing collide, creating dilemmas known to be perceived as difficult for many nurses. Patients in neurosurgical care are at high risk of being subjected to restraint, but research on nurses' experiences of using restraint in neurosurgical care are scarce.

Design

A qualitative, descriptive design guided by a naturalistic inquiry was used.

Methods

Semi‐structured interviews with 15 nurses working in three neurosurgical departments in Sweden were analysed with inductive qualitative content analysis. COREQ reporting guidelines were used as reporting checklist.

Results

The analysis resulted in one overarching theme, The struggling professional, and two categories. The category Internal struggle describes nurses' conflicting emotions and internal struggle when engaging in restraint. The category The struggle in clinical practice, describes how nurses struggle with handling restraint in clinical practice, and how the use of restraint is based on individual assessment rather than guidelines.

Conclusion

Nurses' experience restraint in neurosurgical care as a multi‐layered struggle, ranging from inner doubts to practical issues. In order to enhance patient safety, there is a need for policies and guidelines regarding the use of restraint, as well as structured discussions and reflections for nurses engaged in the practice.

Relevance to clinical practice

The results highlight the importance of clear guidelines, openness, support and teamwork for nurses working with patients at risk to be subjected to restraint, in order to create a safer care for patients as well as healthcare personnel. When developing guidelines and policies concerning restraint in somatic care, both practical issues such as the decision‐making process, and the emotional effect on nurses should be considered.
The effect of per os vs subcutaneous123iodine administration on percentage thyroidal radioactive iodine uptake in normal cats
Authors: Cosford Kevin , Snead Elisabeth , Hutcheson Matt , Sukut Sally
Published: September 2021

Background

Historical and recent literature disagree on whether a higher PO131I dosage, compared to IV or SC routes, is required for successful resolution of spontaneous hyperthyroidism in cats, necessitating investigation into the effect of PO and injectable radioactive iodine administration on % thyroidal radioactive iodine uptake (RAIU).

Hypothesis/Objectives

To investigate the effect of PO and SC routes of123I administration on paired % thyroidal RAIU in euthyroid cats. Specifically, a 1.5‐fold difference (50% relative change) was hypothesized, which in absolute terms can be expressed as a 3.25% increase in the mean %RAIU of 7.04% after PO123I administration to 10.56% after SC dosing.

Animals

Seven healthy euthyroid teaching‐research colony cats.

Methods

A randomized, radiologist‐blinded crossover study comparing %RAIU after PO and SC123I administration.

Results

Percentage thyroidal RAIU values (mean ± SD; 95% confidence interval) after PO (4.81% ± 1.63%; 3.30%‐6.23%) and SC (5.26% ± 2.43%; 3.01%‐7.51%)123I administration were associated with a median within‐pair absolute difference of 0.2% (range: min, 0.1%‐max, 4.9%). Statistical significance was not achieved (P  =  .45). Six of 7 cats had a within‐pair absolute difference of 0.1% to 0.9% (relative change of 4%‐20%), but a single outlier cat had a within‐pair absolute difference of 4.9% (relative change of 108%).

Conclusions and Clinical Importance

This study did not detect an effect of123I administration route on paired % thyroidal RAIU in euthyroid cats. However, a type 2 statistical error due to small sample size is possible.
Retrospective study on the use of lidocaine constant rate infusions for the treatment of ileus in ruminants and camelids
Authors: Yau Katie , Halleran Jennifer , Boileau Melanie , Foster Derek
Published: September 2021

Limited knowledge exists regarding the use of lidocaine as a prokinetic in ruminants and camelids to treat gastrointestinal ileus. In this retrospective study, ruminant and camelid cases diagnosed with ileus and treated with a lidocaine constant rate of infusion were assessed for adverse reactions and medical outcomes. A review of medical records was performed to identify cases in which lidocaine was administered as a prokinetic. Ten cases were identified consisting of 8 cattle, 1 goat, and 1 alpaca. Nine animals improved with a lidocaine treatment. No adverse effects were reported during lidocaine administration. Nine animals were discharged, and 1 was euthanized.
Are immigrants outbred and unrelated? Testing standard assumptions in a wild metapopulation
Authors: Dickel Lisa , Arcese Peter , Nietlisbach Pirmin , Keller Lukas F. , Jensen Henrik , Reid Jane M.
Published: September 2021

Immigration into small recipient populations is expected to alleviate inbreeding and increase genetic variation, and hence facilitate population persistence through genetic and/or evolutionary rescue. Such expectations depend on three standard assumptions: that immigrants are outbred, unrelated to existing natives at arrival, and unrelated to each other. These assumptions are rarely explicitly verified, including in key field systems in evolutionary ecology. Yet, they could be violated due to non‐random or repeated immigration from adjacent small populations. We combined molecular genetic marker data for 150–160 microsatellite loci with comprehensive pedigree data to test the three assumptions for a song sparrow (Melospiza melodia)population that is a model system for quantifying effects of inbreeding and immigration in the wild. Immigrants were less homozygous than existing natives on average, with mean homozygosity that closely resembled outbred natives. Immigrants can therefore be considered outbred on the focal population scale. Comparisons of homozygosity of real or hypothetical offspring of immigrant‐native, native‐native and immigrant‐immigrant pairings implied that immigrants were typically unrelated to existing natives and to each other. Indeed, immigrants’ offspring would be even less homozygous than outbred individuals on the focal population scale. The three standard assumptions of population genetic and evolutionary theory were consequently largely validated. Yet, our analyses revealed some deviations that should be accounted for in future analyses of heterosis and inbreeding depression, implying that the three assumptions should be verified in other systems to probe patterns of non‐random or repeated dispersal and facilitate precise and unbiased estimation of key evolutionary parameters.
Differences in acne therapy prescribing patterns between dermatologists and pediatricians: A population‐based study
Authors: Jones Madison E. , Pourali Sarah P. , Kohn Alison H. , Gutierrez Yasmin , Rajkumar Jeffrey R. , Armstrong April W.
Published: September 2021

Background/Objectives

Acne is a common skin condition that may be treated by both dermatologists and pediatricians. However, the treatments provided by dermatologists and pediatricians may differ. We aimed to describe acne therapy prescribing patterns of dermatologists and pediatricians.

Methods

We performed a population‐based, cross‐sectional analysis using data from the National Ambulatory Medical Care Survey from 2006 to 2016 for pediatric patients (age ≤ 18 years).

Results

There were approximately 30.5 million (weighted) outpatient acne visits between 2006 and 2016 for pediatric patients; 52% of visits were conducted by dermatologists, 29% by pediatricians, and 19% by other providers. Compared to pediatricians, dermatologists saw older patients (mean age 15.5 ± 0.12 vs 13.5 ± 0.35; P < .001), as well as a higher proportion of white patients (92.5% vs 76.3%; P < .001), non‐Hispanic patients (89.5% vs 81.6%; P < .001), and patients with private insurance (84.6% vs 67.8%; P < .001). Compared to patients seen by dermatologists, patients seen by pediatricians were 68% less likely to receive topical retinoids (aOR 0.32, 95% CI 0.22‐0.46), 38% less likely to receive topical antibiotics (aOR 0.62, 95% CI 0.41‐0.95), and 48% less likely to receive oral antibiotics (adjusted aOR 0.52, 95% CI 0.36‐0.75).

Conclusions

Our findings demonstrate that pediatricians prescribe topical retinoids, topical antibiotics, and oral antibiotics less frequently compared to dermatologists. It is important to understand these differences in prescribing patterns for acne and to identify potential educational gaps.
Psoriasis with short stature improved by adalimumab
Authors: Hirano Naoki , Houbara Ryoko , Korematsu Seigo , Hatano Yutaka , Ihara Kenji
Published: September 2021

Few cases of pediatric psoriasis with short stature, possibly resulting from chronic systemic inflammation, have been reported. We present the case of a child with short stature occurring after the onset of psoriasis wherein treatment with adalimumab resulted in the improvement of not only the psoriasis but also the child's short stature. Pediatric psoriasis associated with short stature may benefit from the early induction of biologic therapy.
The natural history of laryngo‐onycho‐cutaneous syndrome: A case series of six pediatric patients and literature review
Authors: Prodinger Christine , Chottianchaiwat Subhanitthaya , Mellerio Jemima E. , McGrath John A. , Ozoemena Linda , Liu Lu , Moore William , Laimer Martin , Petrof Gabriela , Martinez Anna E.
Published: September 2021

Background/Objectives

Laryngo‐onycho‐cutaneous syndrome (LOC) is a rare subtype of junctional epidermolysis bullosa (JEB), featuring aberrant granulation tissue formation in the skin, larynx, and eyes. So far, three mutations including the specific (founder) mutation in exon 39 of LAMA3 (c.151dup) have been identified, but sparse data exists regarding the natural history, the genotype‐phenotype correlation, and its differentiation from other JEB types.

Methods

We reviewed our pediatric EB database to identify English children with clinical and genetically diagnosed LOC within the last 15 years. Their demographic, clinical, and laboratory data were examined. We searched three databases for case reports of LOC between January 1986 and November 2020 and extracted clinical and molecular details.

Results

We identified 6 LOC patients, all female (mean age 5.4 years). Periungual hypergranulation and skin fragility were the earliest presenting signs (0‐3 months), followed by laryngeal stenosis, symblepharon (mean onset 10.7 and 11.8 months, respectively), and dental abnormalities. Five children developed anemia at an average of 19.2 months. We identified 22 published studies in English with 31 cases.

Conclusions

This study delineates the disease course of LOC and highlights the overlap with some forms of JEB. Classical signs/symptoms including anemia appear early in life. Genetic analysis revealed three new LOC‐associated variants and underscores the finding that interpretation of skin immunolabeling and molecular diagnostics can be challenging. We provide recommendations on management of this complex syndrome.
“COVID toes”: A meta‐analysis of case and observational studies on clinical, histopathological, and laboratory findings
Authors: Rocha Kelvin Oliveira , Zanuncio Virgínia Vinha , Freitas Brunnella Alcântara Chagas de , Lima Luciana Moreira
Published: September 2021

Background

Coronavirus disease (COVID‐19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio‐like skin lesions associated with COVID‐19 infection.

Objective

To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio‐like lesions reported in the literature.

Methods

We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory‐confirmed COVID‐19 with pernio‐like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random‐effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi‐square test for dichotomous variables and the Mann‐Whitney test for continuous variables.

Results

A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5‐18.8). Feet were affected in 91.4% (87.0‐94.4%) of patients in observational studies. The proportion of patients with a positive RT‐PCR test was less than 15%. Lesion topography and morphology were associated with age.

Conclusion

Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non‐pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non‐positivity of laboratory tests does not exclude an association with COVID‐19. Pernio‐like lesions may be a late manifestation of COVID‐19.
Photochemistry of Nitrate Ion: Reduction by Formic Acid under UV Irradiation
Authors: Tong Na , Xia Zhonglei , Xie Tianzhu , Liu Xu , Shen Jinni , Zhang Zizhong , Wang Xuxu
Published: September 2021

Mutual transformations of various nitrogen compounds and their reaction mechanisms have been a subject of great concern to the chemical, ecological and environmental communities. In the paper, the reactions of ion with small organic acids such as formic acid (HCOOH), acetic acid (CH3COOH) and lactic acid (C3H6O3) under ultraviolet illumination were investigated systematically. It was found that ion is easily reduced into and NOx and then further into N2 and NH3 (in the form of ) in the process. The carboxyl anion radicals and hydrogen formed by photodecomposition of formic acid are responsible for the rapid photoreduction reaction of nitrate. The initial pH and the nitrate concentration considerably affect the product distribution and nitrate conversion. Based on a preliminary simulation study, we speculated that the photoinduced reaction may effectively proceed in oceans, lakes and rivers because of ever‐increasing nitrate and organic emissions. This research is helpful to understand nitrogen cycle mechanism and develop water environmental control technologies.
Prologue: Black dream geographies
Authors: Jones Naya
Published: September 2021

In this reflective piece, I consider what the discourse surrounding Breonna Taylor's highly publicised killing during a police raid underscores about Black epistemologies of sleep, death, and dying. By using the phrase black dream geographies, I situate this piece in conversation with scholarship on black interiority. At the same time, I extend this conversation by explicitly considering the meanings of dream or sleep in Black/African American epistemologies.
Educación interprofesional y seguridad del paciente: una revisión sistemática.
Authors: Hoyos Maria Cristina , Velásquez Palacio Sandra Milena
Published: September 2021

Introducción: la educación interprofesional (EIP) se dene como una iniciativa educativa, formativa o docente que involucra a más de una profesión en el aprendizaje conjunto e interactivo. La formación del recurso humano en salud tiene como desafío plantear soluciones a la escasez de personal sanitario en el mundo y formar profesionales que tengan un desempeño óptimo. Objetivo: caracterizar las publicaciones relacionadas con la implementación de modelos en educación interprofesional y el impacto generado en algunos aspectos relacionados con la seguridad del paciente. Método: se realizó una revisión sistemática de la literatura cientíca en Pubmed, Science Direct, Scielo, LILACS y Google Scholar con siete estrategias de búsqueda garantizando la exhaustividad y reproducibilidad en las fases de la guía PRISMA. Resultados: se incluyeron n = 33 estudios de los cuales n = 19 (57,5%) fueron aplicados en el contexto hospitalario, n = 14 (42,4%) utilizaron metodologías cuasiexperimentales, de estos n = 4 estudios miden desenlaces directos relacionados con la seguridad del paciente, y en los otros n = 29 (87,8%) se encontró una mejora en la comunicación, percepción y conocimiento en los equipos de trabajo. Conclusión: el aprendizaje interprofesional mejora la comunicación y la interacción entre los profesionales de salud. No obstante, es difícil generalizar los resultados debido a la diversidad de metodologías de interacción interprofesional aplicadas en los estudios.
ZnO/Ag/graphene transparent conductive oxide film with ultrathin Ag layer
Authors: Fang Fang , Wu Junsheng , Yan CaiBo , Zhou Yanwen , Zhao Zhuo
Published: September 2021

We insert a silver (Ag) layer between zinc oxide (ZnO) and graphene films of a bilayer structure to create trilayer transparent conductive oxide films with improved conductivities due to the bridge provided by the Ag layer to transport free electrons. To construct trilayer ZnO/Ag/graphene transparent conductive films, the Ag and ZnO layers are deposited successively on a graphene/glass substrate by magnetron sputtering from solid Ag and powder ZnO targets. The results show that the electron concentration in the trilayer films increases one order of magnitude to 1021 cm−3 upon inserting dispersed Ag dots and three orders of magnitude to 1023 cm−3 upon adding a relatively continuous 10.5-nm-thick Ag layer. However, the electron mobility drops dramatically from 10−1 to 10−2 cm2 V−1 s−1 because the dispersed Ag dots of a thin Ag layer form narrow bridges, which limit electron transport. The continuous 10.5-nm-thick Ag layer not only acts as a wide bridge but also provides electrons; therefore, the resistivity of the ZnO/Ag(continuous)/graphene trilayer decreases significantly, while the mobility of the trilayer film remains of the same order of magnitude as that of the continuous Ag layer. Of course, the transparency of the trilayer film decreases slightly upon inserting the Ag layer. To create frontier electrodes, the ZnO/Ag/graphene multilayer structure must be built up to form transparent conductive oxide films.
“A Lot of What We Ride Is Their Land”: White Settler Canadian Understandings of Mountain Biking, Indigeneity, and Recreational Colonialism
Authors: Reid-Hresko John , Warren Jeff R.
Published: September 2021

This article explores how White settler mountain bikers in British Columbia understand their relationship to recreational landscapes on unceded Indigenous territory. Using original qualitative research, the authors detail three rhetorical strategies settler Canadians employ to negotiate their place within geographies of belonging informed by Indigeneity and recreational colonialism: ignorance, ambivalence, and acknowledgement. In Canada’s post-Truth and Reconciliation Commission climate, the discourses settlers use to situate themselves vis-à-vis landscapes and Indigenous people contribute to the conditions of possibility for meaningful movement toward a more equitable existence for all. This work points to a growing need to problematize the seemingly apolitical landscapes of recreation as a prerequisite toward meaningful reconciliation.
Pharmacokinetic and Safety Profile of the Novel HIV Nonnucleoside Reverse Transcriptase Inhibitor MK-8507 in Adults without HIV
Authors: Ankrom Wendy , Jackson Rudd Deanne , Schaeffer Andrea , Panebianco Deborah , Friedman Evan J. , Tomek Charles , Stoch S. Aubrey , Iwamoto Marian
Published: September 2021

MK-8507 is a novel HIV-1 nonnucleoside reverse transcriptase inhibitor in clinical development with potential for once-weekly oral administration for the treatment of HIV-1 infection. Two randomized, double-blind, placebo-controlled phase 1 studies in adults without HIV-1 evaluated the safety, tolerability, and pharmacokinetics of single and multiple doses of MK-8507; drug interaction with midazolam (a cytochrome P450 3A4 substrate) and food effect were also assessed.
Small cell neuroendocrine tumour of the cervix in pregnancy: the importance of multidisciplinary management
Authors: Bain Esme , Coleridge Sarah Louise , Morrison Jo
Published: September 2021

A woman in her mid-20s presented with bleeding at 18 weeks gestation from a cervical ‘polyp’. Histopathology demonstrated a rare small cell neuroendocrine of the cervix. There were only 18 cases of neuroendocrine tumours of the cervix in and around pregnancy in the literature, so the evidence base for treatment was scarce. She was treated with neoadjuvant chemotherapy, using a regimen used for small cell neuroendocrine tumours of the lung, to allow for fetal lung maturity. Disease initially responded, then progressed and she was delivered at 32 weeks by caesarean radical hysterectomy. Adjuvant treatment included further chemotherapy and radical pelvic radiotherapy. The woman and her child are doing well over 6 years after treatment, although the woman has significant side effects of both radical surgery and radiotherapy. This case emphasises the need for excellent communication between multidisciplinary professionals, patients and their families and using external colleagues to help with rare clinical problems.
Rare case of diffuse large B-cell lymphoma presenting with central pontine myelinolysis
Authors: Nguyen Phillip Cuong , Dunstan Megan , Kumar Beena , Low Michael Sze Yuan
Published: September 2021

Central pontine myelinolysis (CPM) is commonly associated with osmotic stress and rapid correction of hyponatraemia. It has rarely been reported in conjunction with malignancies. We report a case where CPM was not only associated with a new diagnosis of diffuse large B-cell lymphoma but was also a key presenting feature.
Giant ulcerative benign osteochondroma of shoulder
Authors: Pathak Subodh Kumar , Chawla Jasneet Singh , Singh Manjeet , Virk Jagandeep Singh
Published: September 2021

Osteochondromas in hereditary multiple exostosis have increased risk of malignant transformation as compared with solitary osteochondromas. We present a case of a 54-year-old man who presented to us with complaints of swollen mass of the left shoulder with an ulcerative lesion. Radiograph showed a sessile growth from the proximal humerus and scapula. MRI revealed a sessile osteochondroma measuring about 11×10.1×8.0 cm. The malignant nature of the disease was anticipated due to increased cap thickness and non-healing ulcer, however, biopsy showed a benign lesion without any sarcomatous change. The patient was successfully treated with extra-periosteal excision and was recurrence-free at 24 months follow-up. This case illustrates an extra-articular giant osteochondroma of the proximal humerus, with possible signs of a malignant lesion but diagnosed benign on biopsy. We conclude that a biopsy should always preclude definitive management as this can change the overall mortality and morbidity of the patient.
Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis
Authors: Sumangala Salini , Htwe Thidar , Ansari Yousuf , Martinez- Alvarez Lidia
Published: September 2021

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.
Truncus arteriosus as presentation of PHACE syndrome
Authors: Nitiyarom Ekarat , Wisuthsarewong Wanee , Nitiyarom Rattanavalai
Published: September 2021

PHACE syndrome is a rare neurocutaneous syndrome that describes the association of large segmental infantile haemangioma involving the head and neck, along with other systemic anomalies. Complex congenital heart disease has rarely been reported in this syndrome. We present a report of a patient with PHACE syndrome and truncus arteriosus.
Uterine artery embolisation: a rescuer in cervical ectopic pregnancy
Authors: Majumdar Abha , Shekhar Bhawani , Satwik Ambarish
Published: September 2021

Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of massive bleeding and associated morbidity. Managing this condition is challenging for clinicians due to the serious risk to patient and dilemma faced in deciding the appropriate management plan. This case report describes the role of uterine artery embolisation in managing a case of cervical ectopic pregnancy with heavy bleeding per vaginum post methotrexate treatment with falling beta human chorionic gonadotropin (HCG) levels. It highlights the unpredictable nature of this condition and need for prompt intervention in an emergency situation.
Ceramides and phospholipids are downregulated with liraglutide treatment: results from the LiraFlame randomized controlled trial
Authors: Zobel Emilie H , Wretlind Asger , Ripa Rasmus S , Rotbain Curovic Viktor , von Scholten Bernt J , Suvitaival Tommi , Hansen Tine W , Kjær Andreas , Legido-Quigley Cristina , Rossing Peter
Published: September 2021

Introduction

Treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can reduce risk of cardiovascular disease (CVD) in persons living with type 2 diabetes, however the mechanisms explaining this cardiovascular benefit are still debated. We investigated changes in the plasma lipidome following treatment with the GLP-1 RA liraglutide.

Research design and methods

In a double-blind placebo-controlled trial, we randomized 102 persons with type 2 diabetes to liraglutide or placebo for 26 weeks. Fasting blood plasma was collected at baseline and at end-of-treatment. The lipidome was measured using liquid-chromatography-coupled mass-spectrometry as a secondary end point in the study. Treatment response of each lipid was tested with lipid-specific linear mixed-effect models comparing liraglutide with placebo. Bonferroni p<7.1e-03 was employed. The independence of the findings from clinical covariates was evaluated with adjustment for body mass index, HbA1c, fasting status, lipid-lowering treatment and change in lipid-lowering treatment during the trial.

Results

In total, 260 lipids were identified covering 11 lipid families. We observed significant decreases following liraglutide treatment compared with placebo in 21 lipids (p<7.1e-03) from the following lipid families: ceramides, hexocyl-ceramides, phosphatidylcholines, phosphatidylethanolamines and triglycerides. We confirmed these findings in adjusted models (p≤0.01). In the liraglutide-treated group, the individual lipids were reduced in the range of 14%–61% from baseline level, compared with 19% decrease to 27% increase from baseline level in the placebo group.

Conclusions

Compared with placebo, liraglutide treatment led to a significant downregulation in ceramides, phospholipids and triglycerides, which all are linked to higher risk of CVD. These findings were independent of relevant clinical covariates. Our findings are hypothesis generating and shed light on the biological mechanisms underlying the cardiovascular benefits observed with GLP-1 RAs in outcome studies, and further strengthen the evidence base for recommending GLP-1 RAs to prevent CVD in type 2 diabetes.

Trial registration number

NCT03449654.
Simplified models to assess newborn gestational age in low-middle income countries: findings from a multicountry, prospective cohort study
Authors:   The Alliance for Maternal and Newborn Health Improvement (AMANHI) Gestational Age Study Group
Published: September 2021

Introduction

Preterm birth is the leading cause of child mortality. This study aimed to develop and validate programmatically feasible and accurate approaches to estimate newborn gestational age (GA) in low resource settings.

Methods

The WHO Alliance for Maternal and Newborn Health Improvement (AMANHI) study recruited pregnant women from population-based cohorts in five countries (Bangladesh, Ghana, Pakistan, Tanzania and Zambia). Women <20 weeks gestation by ultrasound-based dating were enrolled. Research staff assessed newborns for: (1) anthropometry, (2) neuromuscular/physical signs and (3) feeding maturity. Machine-learning techniques were used to construct ensemble models. Diagnostic accuracy was assessed by areas under the receiver operating curve (AUC) and Bland-Altman analysis.

Results

7428 liveborn infants were included (n=536 preterm, <37 weeks). The Ballard examination was biased compared with ultrasound dating (mean difference: +9 days) with 95% limits of agreement (LOA) −15.3 to 33.6 days (precision ±24.5 days). A model including 10 newborn characteristics (birth weight, head circumference, chest circumference, foot length, breast bud diameter, breast development, plantar creases, skin texture, ankle dorsiflexion and infant sex) estimated GA with no bias, 95% LOA ±17.3 days and an AUC=0.88 for classifying the preterm infant. A model that included last menstrual period (LMP) with the 10 characteristics had 95% LOA ±15.7 days and high diagnostic accuracy (AUC 0.91). An alternative simpler model including birth weight and LMP had 95% LOA of ±16.7 and an AUC of 0.88.

Conclusion

The best machine-learning model (10 neonatal characteristics and LMP) estimated GA within ±15.7 days of early ultrasound dating. Simpler models performed reasonably well with marginal increases in prediction error. These models hold promise for newborn GA estimation when ultrasound dating is unavailable.
Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic
Authors: Oroszi Beatrix , Juhász Attila , Nagy Csilla , Horváth Judit Krisztina , McKee Martin , Ádány Róza
Published: September 2021

Introduction

We describe COVID-19 morbidity, mortality, case fatality and excess death in a country-wide study of municipalities in Hungary, exploring the association with socioeconomic status.

Methods

The spatial distribution of morbidity, mortality and case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised ratios. Indirectly standardised ratios were used to evaluate the association between deprivation and the outcome measures. We looked separately at morbidity and mortality in the 10 districts with the highest and 10 districts with the lowest share of Roma population.

Results

Compared with the national average, the relative incidence of cases was 30%–36% lower in the most deprived quintile but the relative mortality and case fatality were 27%–32% higher. Expressed as incidence ratios relative to the national average, the most deprived municipalities had a relative incidence ratio of 0.64 (CI: 0.62 to 0.65) and 0.70 (CI: 0.69 to 0.72) for males and females, respectively. The corresponding figures for mortality were 1.32 (CI: 1.20 to 1.44) for males and 1.27 (CI: 1.16 to 1.39) for females and for case fatality 1.27 (CI: 1.16 to 1.39) and 1.32 (CI: 1.20 to 1.44) for males and females, respectively. The excess death rate (per 100 000) increased with deprivation levels (least deprived: 114.12 (CI: 108.60 to 119.84) and most deprived: 158.07 (CI: 149.30 to 167.23)). The 10 districts where Roma formed the greatest share of the population had an excess mortality rate 17.46% higher than the average for the most deprived quintile.

Conclusions

Those living in more deprived municipalities had a lower risk of being identified as a confirmed COVID-19 case but had a higher risk of death. An inverse association between trends in morbidity and mortality by socioeconomic conditions should be a cause for concern and points to the need for responses, including those involving vaccination, to pay particular attention to inequalities and their causes.
Media bias exposure and the incidence of COVID-19 in the USA
Authors: Spiteri Jonathan
Published: September 2021

The role of the media as a source of reliable health information during the COVID-19 pandemic has come under intense scrutiny, with claims of misinformation and partisanship coming from all sides of the political divide. This paper seeks to understand the relationship between exposure to biased media outlets and the likelihood of testing positive for COVID-19 in the USA. I use detailed household data extracted from the 2020 American National Election Study in order to gauge media consumption patterns, coupled with data on media bias scores for different outlets and programmes. I combine these variables to compute media bias exposure values for each respondent, and relate these to the likelihood of a positive COVID-19 test within each respondent’s household, controlling for a variety of other factors including partisanship, social media use, trust in the media and several socioeconomic and demographic variables. The results indicate that media bias exposure is significantly related to COVID-19 incidence, and in particular the coefficients show that a 1% increase in exposure to left-wing media is associated with a 0.2% decrease in the probability of a positive COVID-19 test. Conversely, I find no significant relationship between right-wing media exposure and COVID-19 infection rates. I also find a significantly higher likelihood of contracting COVID-19 among low socioeconomic status households, suggesting a disproportionate impact of the pandemic on such cohorts. These findings are robust to a number of tests, and emphasise the importance of aligning media messages with those advocated by leading medical experts during public health crises.
Prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary individuals
Authors: Restar Arjee , Garrison-Desany Henri M , Baker Kellan E , Adamson Tyler , Howell Sean , Baral Stefan David , Operario Don , Beckham S Wilson
Published: September 2021

Background

Testing for COVID-19 and linkage to services is fundamental to successful containment and control of transmission. Yet, knowledge on COVID-19 testing among transgender and non-binary communities remains limited.

Methods

Between October 2020 and November 2020, we examined the prevalence and associations of COVID-19 testing in an online sample of transgender and non-binary people (n=536). Multivariable hierarchical logistic regression analyses examined associations between COVID-19 testing and participants’ sociodemographic, mental health, substance use, gender affirmation, economic changes and healthcare experiences.

Results

Prevalence of COVID-19 testing in this sample was 35.5% (n=190/536). In the final model, transgender and non-binary participants from upper socioeconomic income background and Europe, who reported having active alcohol use disorder, limited access to gender-affirming surgery, had more than 20% reduction in income, and experienced mistreatment in a health facility due to gender identity had significantly increased odds of COVID-19 testing (all p<0.05); those who reported recent tobacco use had significantly lower odds of COVID-19 testing (p=0.007).

Conclusions

These findings highlight structural disparities in COVID-19 testing and reinforce the importance of increasing testing strategies for transgender and non-binary populations.
Aetiology and risk factors of bacterial gastroenteritis among febrile outpatients at the Dschang District Hospital, West Region of Cameroon: a cross-sectional study
Authors: Ousenu Karimo , Sama Leonard Fonkeng , Ali Innocent Mbulli , Fonbah Jude Leinyuy , Nadine Ongbayokolak Sylvie , Dabou Solange , Tume Christopher
Published: September 2021

Objectives

To investigate the bacterial aetiologies and associated risk factors of gastroenteritis among typhoid suspected cases.

Design

Cross-sectional study.

Setting

This study was conducted at Dschang District Hospital of the Menoua Division, West Region of Cameroon, between April–November 2019 and June 2020.

Participants

Participants aged ≥2 years (mean 34±18.77 years) and of both sex suspected of having typhoid fever were included, while non-suspected typhoid cases were excluded. Self-reported sociodemographic and health information at recruitment was obtained from 556 participants.

Methods

Collected stool samples were examined macroscopically and microscopically and subjected to culture. After culture, Gram staining was performed, followed by biochemical testing and characterisation using the Analytical Profile Index (API-20E) test kit.

Interventions’

No intervention was done during the period of study.

Outcome measures

We identified bacterial causing gastroenteritis, and associated risk factors calculated using binary regression, adjusting for sociodemographic and health variables.

Results

Of 556 patients, 74.28% tested positive for gastroenteritis. Among pathogens responsible for gastroenteritis,Escherichia coliwas found to be the main cause (21.1%), followed bySalmonella typhi(10.4%),Citrobacter diversus(8.2%),and Proteus mirabilis(8.2%),Proteus vulgaris(7.3%), whereasCitrobacterspp andYersinia enterocoliticawere less represented among pathogens causing the disease among patients. A significant difference (p=0.002) was observed between abdominal pain and all the micro-organisms isolated from the patients. Patients having primary level of education were significantly associated (p=0.017; 3.163 (95% CI 1.228 to 8.147)) with the prevalence of gastroenteritis. Consumption of beverages (Wald statistic: 4.823; OR: 2.471; 95% CI (1.102 to 5.539); p=0.028), use of modern toilet (Wald statistic: 4.471; OR: 1.723; 95% CI (1.041 to 2.852); p=0.034) were strongly associated with gastroenteritis and rearing of bird (Wald statistic: 4.880; OR: 0.560; 95% CI (0.335 to 0.937); p=0.027), was found to be protective.

Conclusion

Acute bacterial gastroenteritis is a significant cause of morbidity in Dschang, with the prevalence of 74.28%. Many pathogens accounted for gastroenteritis, andE. coli(21.1%) could be a major cause, followed byS. typhi(10.4%),C. diversus(8.2%),P. mirabilis(8.2%),P. vulgaris(7.3%), whereasCitrobacterspp andY. enterocoliticawere less represented. Gastroenteritis was highly associated with primary level of education, consumption of beverages, use of modern toilet while rearing of birds was unexpectedly found to be protective against Gastroenteritis. Further characterisation is planned.
Individually tailored self-management app-based intervention (selfBACK) versus a self-management web-based intervention (e-Help) or usual care in people with low back and neck pain referred to secondary care: protocol for a multiarm randomised clinical trial
Authors: Marcuzzi Anna , Bach Kerstin , Nordstoga Anne Lovise , Bertheussen Gro Falkener , Ashikhmin Ilya , Boldermo Nora Østbø , Kvarner Else-Norun , Nilsen Tom Ivar Lund , Marchand Gunn Hege , Ose Solveig Osborg , Aasdahl Lene , Kaspersen Silje Lill , Bardal Ellen Marie , Børke Janne-Birgitte , Mork Paul Jarle , Gismervik Sigmund
Published: September 2021

Introduction

Low back pain (LBP) and neck pain (NP) are common and costly conditions. Self-management is a key element in the care of persistent LBP and NP. Artificial intelligence can be used to support and tailor self-management interventions, but their effectiveness needs to be ascertained. The aims of this trial are (1) to evaluate the effectiveness of an individually tailored app-based self-management intervention (selfBACK)adjunct to usual care in people with LBP and/or NP in secondary care compared with usual care only, and (2) to compare the effectiveness ofselfBACKwith a web-based self-management intervention without individual tailoring (e-Help).

Methods and analysis

This is a randomised, assessor-blind clinical trial with three parallel arms: (1)selfBACKapp adjunct to usual care; (2) e-Help website adjunct to usual care and (3) usual care only. Patients referred to St Olavs Hospital, Trondheim (Norway) with LBP and/or NP and accepted for assessment/treatment at the multidisciplinary outpatient clinic for back or neck rehabilitation are invited to the study. Eligible and consenting participants are randomised to one of the three arms with equal allocation ratio. We aim to include 279 participants (93 in each arm). Outcome variables are assessed at baseline (before randomisation) and at 6-week, 3-month and 6-month follow-up. The primary outcome is musculoskeletal health measured by the Musculoskeletal Health Questionnaire at 3 months. A mixed-methods process evaluation will document patients’ and clinicians’ experiences with the interventions. A health economic evaluation will estimate the cost-effectiveness of both interventions’ adjunct to usual care.

Ethics and dissemination

The trial is approved by the Regional Committee for Medical and Health Research Ethics in Central Norway (Ref. 2019/64084). The results of the trial will be published in peer-review journals and presentations at national and international conferences relevant to this topic.

Trial registration number

NCT04463043.
Gambling and the COVID-19 pandemic in the province of Quebec (Canada): protocol for a mixed-methods study
Authors: Brodeur Magaly , Audette-Chapdelaine Sophie , Savard Annie-Claude , Kairouz Sylvia
Published: September 2021

Introduction

The COVID-19 pandemic has major collateral impacts on mental health. Gambling is among the major public health issues that seems to have been transformed by the pandemic. In the province of Quebec in Canada, gambling is an important leisure activity. About two out of three adults are in Quebec gamble. The objective of this study is to draw a portrait of the impacts of the COVID-19 pandemic on gamblers and to learn more about their experiences during the pandemic in the province of Quebec.

Method and analysis

This study has a sequential explanatory mixed-method design in two phases. The first phase is a cross-sectional online survey with Quebec residents who are 18 years of age or older and have gambled at least once in the previous 12 months. The second phase will be a qualitative study. Semistructured interviews will be conducted with gamblers, family members, addiction counsellors and state representatives selected through purposing sampling.

Ethics and dissemination

This study is one of the first mixed-methods studies on the impacts of the COVID-19 pandemic on gambling. This study will generate new scientific knowledge on a worrisome public health issue, that is, gambling, and provide a better understanding of the experiences and gambling behaviours of gamblers during the pandemic. This study is funded by the Ministry of Health and Social Services of the Government of Quebec and was approved on 27 October 2020 by the Scientific and Research Ethics Committee of the CIUSSS de l’Estrie-CHUS. This is a 2-year study that will be completed in June 2022.