bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors
Authors: Anguiano Mª Carmen Castillejos , Pérez Carlos Martín , Aragon Antonio Bordallo , Muñoz Jesus Sepúlveda , Küstner Berta Moreno
Published: October 2020

Background. Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners.Methods. A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: a) patient variables (sociodemographic and clinical), b) general practitioner variables, and c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed.Results. A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners.Conclusions. The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders.
Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial
Authors: Delvaux Nicolas , Piessens Veerle , De Burghgraeve Tine , Mamouris Pavlos , Vaes Bert , Stichele Robert Vander , Cloetens Hanne , Thomas Josse , Ramaekers Dirk , De Sutter An , Aertgeerts Bert
Published: October 2020

Background Inappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.Methods This study was a pragmatic, cluster randomized, open label, controlled clinical trial. Setting 280 general practitioners (GPs) from 72 primary care practices in Belgium. Patients Patients aged ≥18 years with a laboratory test order for at least one of 17 indications; cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication. Interventions The CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician. Measurements The primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume and cascade activities.Results CDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16 - 0.26, p<.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37 - 10.93, p=.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease - 0.05% increase) in possible diagnostic error.Conclusions A CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error. Trial Registration Clinicaltrials.gov Identifier: NCT02950142, registered on October 25, 2016Funding source This study was funded through the Belgian Health Care Knowledge Centre (KCE) Trials Programme agreement KCE16011.
Consecutive Observation of Dynamic Metastases of Human Ovarian Carcinoma to Grading Lymph Nodes in Mouse Model
Authors: Du Licheng , Kong Fenghua , Yang Qing , Li Yaqiong , Ding Peikai , Yu Guoxiang , Yao Yiping , Zhao Yueran , Tian Xingsong
Published: October 2020

Background：Lymphogenous metastasis, one of the most common dissemination routes for ovarian carcinoma, predicts a poor prognosis and relates to most cancer-related death. Now there were no effective therapy and control methods for ovarian carcinoma. Hence, it is necessary to build an animal model of lymph node metastasis in ovarian cancer to seek for the tools to find effective treatments. Our purpose of this study was to investigate the tumor cell dissemination of ovarian carcinoma to the gradient lymph nodes of nude mice and its possible mechanism.Methods: The mice models of VEGF-D over-expressed were built, and the tumor growth and sentinel lymph nodes were evaluated weekly, while the visible lymph nodes and tumor masses were excised for histological examination using HE examination. Then Evan’s Blue was conducted to observe the unveil lymphatic network. Subsequently, immunohistochemistry (IHC) was performed to check the protein expression of relative genes. Meanwhile, microvessel counting was performed within the tumor tissues and measured using computer assisted morphometric analysis.Results: The over-expression of VEGF-D promoted the tumor growth of ovarian carcinoma, facilitated the hyperplasia of tumor lymphatic and increased the intratumoral lymphatic vessel density. Besides, the up-regulation of VEGF-D induced the expression of MMP-2, which might be the underlying mechanism of the lymph metastasis in ovarian cancer.Conclusion: It was a step-by-step progression from the inoculation of cancer cells to the proliferation of the primary tumors, and then to the lymphatic metastases, in which VEGF-D and MMP-2 played vital roles.
Tannic acid-modified silver nanoparticles enhance anti-Acanthamoeba activity without increasing cytotoxicity of three multipurpose contact lens solutions
Authors: Hendiger Edyta Beata , Padzik Marcin , Żochowska Agnieszka , Baltaza Wanda , Olędzka Gabriela , Zyskowska Diana , Bluszcz Julita , Jarzynka Sylwia , Chomicz Lidia , Grodzik Marta , Hendiger Jacek , Piñero Jose E. , Grobelny Jarosław , Ranoszek-Soliwoda Katarzyna , Lorenzo-Morales Jacob
Published: October 2020

Background: Free living amoebae of the genus Acanthamoeba are cosmopolitan, widely distributed protozoans causing a severe, vision-threatening corneal infection known as Acanthamoeba keratitis (AK). The majority of the increasing number of AK cases are associated with contact lenses use. Appropriate eye hygiene and effective contact lenses disinfection are crucial in prevention of this infection because of the lack of effective therapies against AK. Currently available multipurpose contact lens disinfection systems are not fully effective against Acanthamoeba trophozoites and cysts. There is an urgent need to increase the disinfecting activity of these systems to prevent Acanthamoeba keratitis infections. Synthesized nanoparticles have been recently studied and proposed as a new generation of anti-microbial agents. It is also known that plant metabolites, including tannins, present anti-parasitic activity. The aim of this study was to evaluate the anti-amoebic activity and cytotoxicity of the tannic acid-modified silver nanoparticles (AgTANPs) conjugated with the selected multipurpose contact lens solutions.Methods: The anti-amoebic activity of pure contact lens care solutions and nanoparticles conjugated with contact lens care solutions were examined in vitro by a colorimetric assay, based on the oxido-reduction of AlamarBlue. The cytotoxicity assays were performed using a fibroblast HS-5 (ATCC CRL-11882) cell line. The results were statistically analyzed by ANOVA and Student-Newman-Keuls tests using the p<0.05 level of a statistical significance.Results: We show that nanoparticles enhanced anti-Acanthamoeba activity of the tested contact lens solutions without increasing their cytotoxicity profile. The activity is enhanced within the minimal disinfection time recommended by the manufacturer.Conclusions: The conjugation of the selected contact lens solutions with AgTANPs might be a novel and promising approach as a part of preventive actions of Acanthamoeba keratitis infections among contact lens users.
Neutrophil-to-lymphocyte ratio has limited predictive value for determining outcomes in perforated colon cancer: a retrospective study.
Authors: Wu Chunyi , Chiang Jy-Ming , You Jeng-Fu , Tang Reiping , Chen Jinn-Shiun , Yeh Chien-Yuh , Hsieh Pao-Shiu , Tsai Wen-Sy , Hung Hsin-Yuan , Chiang Sum-Fu , Lai Cheng-Chou
Published: October 2020

Background: The neutrophil-to-lymphocyte ratio is a significant prognostic marker in resectable colorectal cancer; however, there are no equivalent findings for perforated colon cancer. Using our colorectal cancer database, we retrospectively analyzed the data from 1995 to 2015 to determine whether the preoperative neutrophil-to-lymphocyte ratio is associated with survival outcomes in patients with perforated colon cancer.Methods: One-to-one propensity score matching was applied to minimize the difference between the high (>5) and low (≤5) neutrophil-to-lymphocyte ratio groups. Clinicopathological factors, long-term overall survival, and disease-free survival were analyzed and compared between the two groups. The primary outcomes were overall survival and disease-free survival.Results: Before propensity score matching, the high neutrophil-to-lymphocyte ratio group had a significantly higher prevalence of leukocytosis (low vs. high neutrophil-to-lymphocyte ratio groups: 12 [12.9%] vs. 46 [59.7%], p<0.001), lower serum albumin levels (low vs. high neutrophil-to-lymphocyte ratio groups: 30 [32.3%] vs. 42 [54.5%], p=0.003), and a higher emergent operation rate (low vs. high neutrophil-to-lymphocyte ratio groups: 5 [5.4%] vs. 20 [26.0%], p<0.001). After one-to-one propensity score matching, the groups comprised 41 patients each; none of the parameters were significantly different between the two groups. The mean follow-up period was 76.3 months. The 5-year overall survival (p=0.637) and disease-free survival (p=0.827) rates were not significantly different between the high and low neutrophil-to-lymphocyte ratio groups.Conclusions: The neutrophil-to-lymphocyte ratio has limited predictive value for determining outcomes in patients with perforated colon cancer.
Evaluation of the Relationship Between NIRS (Near-Infrared Spectroscopy) and Optic Nerve Sheath Diameter Measurement in Children with Increased Intracranial Pressure: A Pilot Study
Authors: Arslan Didar , Yildizdas Dinçer , HOROZ Özden ÖZGÜR , Aslan Nagehan , İNCECİK Faruk
Published: October 2020

Background: The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been increasing. In this study, our objective was to determine the significance of ONSD (Optic Nerve Sheath Diameter) and NIRS (Near-Infrared Spectroscopy) in children with increased ICP and any possible correlation between ONSD and NIRS. Methods: Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results: A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n=9; 25%) and non-traumatic bleeding (n=7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8±0.7 mm and 71.1±12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1±0.6 mm and 72.7±9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6±0.7 mm and 74.2±16% respectively. There was no correlation between the ONSD and NIRS values (r:0.3; p=0.07).Conclusion: Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.
Glycopyrrolate for Drooling in Children with Medical Complexity Under Three Years of Age
Authors: Lovardi Eleonora , De Ioris Maria Antonietta , Lettori Donatella , Geremia Caterina , Staccioli Susanna , Bella Gessica Della , Scrocca Raffaella , Scarselli Alessia , Aversa Marcella , De Peppo Francesco , Campana Andrea , Castelli Enrico
Published: October 2020

Background: The aim of the study is to determine that Glycopirrolate is safe and effective in decreasing drooling in children with medical complexity under three years of age. Medical treatment is based on anticholinergic drugs as transdermal scopolamine, benzotropine and GLY. GLY (Glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent with poor blood–brain barrier penetration and consequently has limited central effects. Actually, the oral GLY formulation was approved by the United States Food and Drug Administration (FDA) to treat drooling in children aged 3-16 years. Five studies reported on GLY use for the treatment of drooling in children with cerebral palsy and other conditions with neurological impairment; four are prospective studies while one a retrospective review. Methods: this is a case report of eighteen children (sex ratio 11/8, median age 17 months, range 2-36 months) under three years of age, followed by a multidisciplinary team at the Bambino Gesù Children Hospital. The median follow-up was of 31.5 months (range 1-69 months). Response to treatment was assessed according to the Drooling Impact Scale administered at time 0 and after 1 month. All patients have an important neurological impairment: nine patients have a cerebral palsy (Gross Motor Function Classification System class V) and nine a genetic/malformative syndrome. Twelve patients have a tracheostomy and two need mechanical ventilation. Gastrostomy is present in 16 out of 18 patients. All patients received Glycopirrolate. The median starting daily dose was 0.065 mg/kg/die (range 0.02-0.21 mg/kg/die) three times a day. The drooling impact scale was administered at time O and after 1 month. Results: Four out 18 patients stopped treatment for adverse event, lack of efficacy or parental decision. The mean Drooling Impact Scale at time 0 was 89 (range 81-100) and after one month 61(range 43-78); the difference was statistically significant (P <0.001). The overall response to treatment was 94%. Conclusions: This is the first study to determine the safety and effectiveness of Glycopyrrolate in decreasing drooling in a specific subset of patients. No major side effects were observed. Further comparative studies are needed to confirm our results.
Scintigraphic Tracking of 99mTechnetium Labelled Equine Peripheral Blood-Derived Mesenchymal Stem Cells After Intravenous, Intramuscular and Subcutaneous Injection in Healthy Dogs.
Authors: Beerts Charlotte , Brondeel Carlien , Pauwelyn Glenn , Depuydt Eva , Tack Liesa , Duchateau Luc , Xu Yangfeng , Saunders Jimmy H. , Peremans Kathelijne , Spaas Jan H.
Published: October 2020

Background: Mesenchymal stem cell treatments in dogs have been investigated as a potential innovative alternative to current conventional therapies for a variety of conditions. So far, the precise mode of action of the MSCs has yet to be determined. The aim of this study was to gain more insights in the pharmacokinetics of MSCs by evaluating their biodistribution in healthy dogs after different injection routes.Methods: Three different studies were performed in healthy dogs to evaluate the biodistribution of radiolabelled equine peripheral blood-derived mesenchymal stem cells following intravenous, intramuscular and subcutaneous administration in comparison with free 99mTechnetium. The labelling of the equine peripheral blood-derived mesenchymal stem cells was performed using stannous chloride as reducing agent. Whole body scans were obtained using a gamma camera during a 24h follow-up.Results: The labelling efficiency ranged between 59.58 and 83.82%. Free 99mTechnetium accumulation was predominantly observed in stomach, thyroid, bladder and salivary glands while, following intravenous injection, the 99mTechnetium labelled equine peripheral blood-derived mesenchymal stem cells majorly accumulated in the liver throughout the follow-up period. After intramuscular and subcutaneous injection, the injected dose percentage remained very high at the injection site.Conclusions: A distinct difference was noted in biodistribution of the radiolabelled equine peripheral blood-derived mesenchymal stem cells compared to free 99mTechnetium indicating equine peripheral blood-derived mesenchymal stem cells have a specific pharmacokinetic pattern after systemic administration in healthy dogs. Furthermore, the natural biodistribution pattern of the used equine peripheral blood-derived mesenchymal stem cells appeared to be different to previously reported experiments using different sources of mesenchymal stem cells.
Field effect transistor to enable registration of reaction energy pathways
Authors: Kuznetsov Alexander E. , Andrianova Mariia S. , Kuznetsov Evgeniy V.
Published: October 2020

Each chemical reaction has its own energy profile that represents the energy changes during the transformation of reactants into products. Together with other sources, it provides information about the reaction mechanism. Here, we show how a complementary metal-oxide-semiconductor (CMOS)–compatible field effect transistor can be used to register an energy pathway of a chemical reaction. As a proof of concept we record an energy profiles (energy changes vs. reaction coordinate) of 3,3′,5,5′-tetramethylbenzidine oxidation catalyzed by horseradish peroxidase. This approach can be potentially extended to study other enzymatic and non-enzymatic reactions.
Clara Cell 10-kDa Protein is a Sensitive Biomarker to Identify Th2 Subtype Inflammatory Phenotypes of Asthma
Authors: Wang Meijia , Tang Kun , Gao Pengfei , Lu Yanjiao , Wang Shanshan , Zhao Jianping , Xie Jungang
Published: October 2020

Background: Clara cell 10-kDa protein (CC10) is one of the most abundant proteins in bronchoalveolar lavage fluis and has been described as a biomarker for airway obstructive diseases. CC10 possesses the properties of suppression Th2 cell differentiation and Th2 cytokine production. In this study, we aimed to determine whether CC10 can be a sensitive biomarker to identify Th2 phenotypes of asthma.Methods: Adults with asthma (n = 50) were categorized as Th2-high asthma or Th2-low asthma according to serum IgE, blood eosinophils and fractional exhaled nitric oxide (FeNO). Patients were classified as Th2-high asthma when two or more biomarkers (high IgE ≥ 100 IU/mL, high Eos ≥ 300/µL, or high FeNO ≥ 30 ppb) were elevated, and classified as Th2-low asthma when one or no biomarker was elevated. Enzyme-linked immunosorbent assay (ELISA) was used to assess the CC10 and periostin levels in plasma. All participants underwent sputum induction, and different types of inflammatory cells were counted.Results: The plasma CC10 levels from patients with Th2-low asthma were higher than patients with Th2-high asthma（P<0.001. The receiver-operating characteristic (ROC) analysis showed a sensitivity of 0.73 and specificity of 0.74 for plasma CC10 of 19.76 ng/ml to distinguish asthmatic patents with Th2-high phenotype or Th2-low phenotype. Correlation analysis indicated that the plasma CC10 levels were inversely correlated with plasma periostin, sputum eosinophil and negative logPD20 (p＜0.05), however positively correlated with sputum neutrophil percentages and FEV1 % predictions (p＜0.05). Conclusions: The plasma CC10 was potentially useful in predicting Th2-high and Th2-low phenotypes in patients with asthma. Lower plasma CC10 was associated with enhanced airway hyperresponsiveness, Th2-high inflammation and subsequent airflow limitation.
The Dysbiosis of Ovine Foot Microbiome During the Development and Treatment of Contagious Ovine Digital Dermatitis
Authors: Duncan Jennifer S , Angell Joseph W , Richards Peter , Lenzi Luca , Staton Gareth J , Grove-White David , Clegg Simon , Oikonomou Georgios , Carter Stuart , Evans Nicholas
Published: October 2020

Background: Contagious Ovine Digital Dermatitis (CODD) is an emerging and common infectious foot disease of sheep which causes severe welfare and economic problems for the sheep industry. The aetiology of the disease is not fully understood and control of the disease is problematic. The aim of this study was to investigate the polybacterial aetiopathogenesis of CODD and the effects of antibiotic treatment, in a longitudinal study of an experimentally induced disease outbreak using a 16S rRNA gene amplicon sequencing approach.Results: CODD was induced in 15/30 experimental sheep. During the development of CODD three distinct phenotypic lesion stages were observed. These were an initial interdigital dermatitis (ID) lesion, followed by a footrot (FR) lesion, then finally a CODD lesion. Distinct microbiota were observed for each lesion in terms of microbial diversity, clustering and composition. Porphyromonadaceae, Familiy XI, Veillonellaceae and Fusobacteriaceae were significantly associated with the diseased feet. Veillonellaceae and Fusobacteriaceae were most associated with the earlier stages of ID and footrot rather than CODD. Following antibiotic treatment of the sheep, the foot microbiota showed a strong tendency to return to the composition of the healthy state. The microbiota composition of CODD lesions collected by swab and biopsy methods were different. In particular, the Spirochaetaceae family were more abundant in samples collected by the biopsy method, suggesting that these bacteria are present in deeper tissues of the diseased foot. Conclusion: In this study, CODD presented as part of a spectrum of poly-bacterial foot disease strongly associated with bacterial families Porphyromonadaceae, Family XI (a family in Clostridiales also known as Clostridium cluster XI), Veillonellaceae and Fusobacteriaceae which are predominately Gram-negative anaerobes. Following antibiotic treatment, the microbiome showed a strong tendency to return to the composition of the healthy state. The composition of the healthy foot microbiome does not influence susceptibility to CODD. Based on the data presented here and that CODD appears to be the severest end stage of sheep infectious foot disease lesions, better control of the initial ID and FR lesions would enable better control of CODD and enable better animal welfare.
GLP-1R Activation Ameliorate Novel-object Recognition Function via Hippocampal AMPK/NF-κB Signaling Pathway in Neuropathic Pain Mice
Authors: Zhang Long-Qing , Zhang Wen , Li Ting , Yang Ting , Yuan Xiaoman , Zhou Yaqun , Zou Qian , Yang Hui , Gao Feng , Tian Yuke , Mei Wei , Tian Xue-Bi
Published: October 2020

Background: Growing evidences indicate that neuropathic pain is frequently accompanied with cognitive impairments, which aggravate the decrease in the quality of life of chronic pain patients. Furthermore, it has been shown that the activation of Glucagon-like-peptide-1receptor (GLP-1R) improved memory deficit in multiple diseases such as Alzheimer’s disease (AD), stroke and so on. However, whether activating GLP-1R could improve memory impairment induced by neuropathic pain and the mechanism by which this improvement would occur remain unclear. Methods: The spared nerve injury (SNI) model was established as a kind of neuropathic pain. And novel-object recognition memory (hippocampus-dependent memory) was tested by the novel object recognition test (NORT).The expression levels of GLP-1,GLP-1R,adenosine monophosphate-activated protein kinase (AMPK),p-AMPKThr172, nuclear factor κ B p65 (NF-κB p65), interleukin-1β p17(IL-1β p17),and the synaptic associated proteins were tested in the murine hippocampus with memory deficits caused by neuropathic pain. Then, exenatide acetate (Ex-4, a GLP-1R agonist), exendin(9-39)(Ex(9-39),a GLP-1R antagonist) and Compound C dihydrochloride ( CC, an AMPK inhibitor) were used to test the effects of activating GLP-1R in mice with neuropathic pain.Results: First, we uncovered that neuropathic pain could inhibit GLP-1/GLP-R axis, disturb inflammatory signaling pathway, increase the expression of IL-1β and downregulate the synaptic associated proteins (postsynaptic density protein 95(PSD95) and Arc). Subsequently, we reported that Ex-4 treatment could improve recognition memory impairment and increase the ratio of p-AMPKThr172/AMPK, decrease the expression of NF-κB p65 and IL-1β p17, upregulate the levels of PSD95 and Arc. Moreover, we uncovered that Ex(9-39) and CC treatment could abrogate the neuroprotection of Ex-4 in mice with memory impairment induced by neuropathic pain.Conclusions: The results indicated that the activation of GLP-1R could improve recognition memory impairment caused by neuropathic pain via activating AMPK signaling pathway, then, which could inhibit NF-κB activating and its downstream IL-1β expression, upregulate the levels of PSD95 and Arc proteins.
Detection of Antiretroviral treatment failure among adult HIV-1 patients on anti-retroviral therapy for 12 +/- 3 months attending different Voluntary Counseling Testing and treatment centers in Khartoum state, Sudan
Authors: Ibrahim Nafisa Ahmed , Enan Khalid A , Yagoup Mahdi Mustafa , Elhag Wafa Ibrahim
Published: October 2020

Objective: Small number of people on antiretroviral therapy and their virological status in Sudan is lacking. This study aimed to determine the viral load for adult HIV-1 patients who were on antiretroviral therapy for 12+/- 3 months attending different Voluntary Counseling Testing and treatment centers (VCT/ART) in Khartoum state, Sudan.Results: out of 112 adult HIV-1 patients included in this study, only 17.9% (20/112) showed unsuppressed viral load (treatment failure). The majority of them from Omdurman VCT/ART center 80% (16/20), followed by Khartoum VCT/ART center 15% (3/20), Bahri VCT/ART center 5% (1/20) and non from Elban Gadeid VCT/ART center. All of them were on the first line of treatment. Most of them 30% (6/20) on 39-48 years old age group, the majority of them 55%(11/20) on stage 3 WHO clinical staging.
Risk Factors for Surgical Site Infection in Spinal Surgery and Interventions: A Retrospective Study
Authors: Saruwatari Rikiya , Yamada Kei , Sato Kimiaki , Yokosuka Kimiaki , Yoshida Tatsuhiro , Nakae Ichiro , Shimazaki Takahiro , Morito Shinji , Shiba Naoto
Published: October 2020

Background: Surgical site infection following spinal surgery causes prolonged delay in recovery after surgery, increases cost, and sometimes leads to additional surgical procedures. We investigated risk factors for the occurrence of surgical site infection events in terms of patient-related, surgery-related, and postoperative factors.Methods: This retrospective study included 1000 patients who underwent spinal surgery in our hospital between April 2016 and March 2019. Before September 2015, we observed multiple occurrences of spinal surgical site infections caused by methicillin-resistant Staphylococcus aureus, and we have since been culturing swabs taken from inside and outside the wound before postoperative wound closure as a form of surgical site infection surveillance.Results: The patient-related factors of dementia, length of preoperative hospital stay (≥14 days), diagnosis at the time of surgery (traumatic injury or deformity), surgery-related factor of multilevel surgery (≥9 intervertebral levels), and postoperative factor of time to ambulation (≥7 days) were statistically significant risk factors for spinal surgical site infection. A retrospective study of 392 patients who underwent spinal surgery between June 2009 and August 2011, before surgical site infection surveillance was implemented, showed that the incidence of surgical site infection was 4.59%, although in this study, it had dropped to 2.0%.Conclusion: The introduction of surgical site infection surveillance thus helps reduce the incidence of surgical site infection through measures taken by medical staff to prevent them and to improve associated problems. One risk factor identified in this study that is amenable to intervention is the time to ambulation. As delayed ambulation is a risk factor for postoperative surgical site infection, how medical staff can intervene in postoperative ambulation to further reduce the incidence of surgical site infection is a topic for future research.
Intralymphatic Immunotherapy: A 3-year Randomized, Double-blind Study in 72 Patients With Allergic Rhinitis Due to Birch and Grass
Authors: Ahlbeck Lars , Ahlberg Emelie , Björkander Janne , Aldén Caroline , Papapavlou Georgia , Palmberg Laura , Nyström Ulla , Retsas Pavlos , Nordenfelt Patrik , Togö Totte , Johansen Pål , Rolander Bo , Jenmalm Maria , Nilsson Lennart
Published: October 2020

Background: There is need for a fast, efficient, and safe way to induce tolerance in patients with severe allergic rhinitis.Methods: Patients with severe birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5-grass allergen extracts (10,000 SQ units/ml, ALK-Abelló), or birch and placebo or 5-grass and placebo by ultrasound-guided injections into inguinal lymph nodes at monthly intervals. We have no clean placebo group but the pollen seasons are mostly divided by time. Rhinoconjunctivitis Total Symptom Score, Medication Score and Rhinoconjunctivitis Quality of Life Questionnaire were evaluated before treatment and after each birch and grass pollen season during three subsequent years. Circulating proportions of T helper subsets and allergen-induced cytokine and chemokine production were analyzed by flow cytometry and Luminex.Results: The three groups reported fewer symptoms, lower use of medication and improved quality of life during the birch and grass pollen seasons each year after treatment at an almost similar rate independently of treatment. Mild local pain was the most common adverse event. IgE levels to birch decreased, whereas birch-induced IL-10 secretion increased in all three groups. IgG4 levels to birch and timothy and skin prick test reactivity remained mainly unchanged. Conjunctival challenge tests with timothy extract showed a higher threshold for allergen. In all three groups, regulatory T cell frequencies were increased three years after treatment.Conclusion: Intralymphatic immunotherapy against grass and birch pollen allergy was safe, seemed to be effective, and to be associated with bystander immune modulatory responses.Trial registration: EudraCT (2013-004726-28). Registered 14 January 2014https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-004726-28
Fine Particulate Matter Constituents Associated With Emergency Room Visits for Pediatric Asthma: A Time-Stratified Case–Crossover Study in an Urban Area
Authors: Ho Yu-Ni , Cheng Fu-Jen , Tsai Ming-Ta , Tsai Chih-Min , Chuang Po-Chun , Cheng Chi-Yung
Published: October 2020

Background: Global asthma-related mortality tallies at around 2.5 million annually. Although asthma may be triggered or exacerbated by particulate matter (PM) exposure, studies investigating the relationship of PM and its components with emergency department (ED) visits for pediatric asthma are limited. This study aimed to estimate the impact of short-term exposure to PM constituents on ED visits for pediatric asthma. Methods: We retrospectively evaluated non-trauma patients aged younger than 17 years who visited the ED with a primary diagnosis of asthma. Further, measurements of PM10, PM2.5, and four PM2.5 components (i.e., nitrate (NO3−), sulfate (SO42−), organic carbon (OC), and elemental carbon (EC)) were collected between 2007 and 2010 from southern particulate matter supersites. These included one core station and two satellite stations in Kaohsiung City, Taiwan. A time‐stratified case‐crossover study was conducted to analyze the hazard effect of PM. Results: Overall, 1597 patients were enrolled in our study. In the single-pollutant model, the estimated risk increase for pediatric asthma incidence on lag 3 were 14.7% [95% confidence interval (CI), 3.2–27.4%], 13.5% (95% CI, 3.3–24.6%), 14.8% (95% CI, 2.5–28.6%), and 19.8% (95% CI, 7.6–33.3%) per interquartile range increments in PM2.5, PM10, nitrate, and OC, respectively. In the two-pollutant models, OC remained significant after adjusting for PM2.5, PM10, and nitrate. During subgroup analysis, children were more vulnerable to PM2.5 and OC during cold days (<26°C, interaction p=0.008 and 0.012, respectively). Conclusions: Both PM2.5 concentrations and its chemical constituents OC and nitrate are associated with ED visits for pediatric asthma. Among PM2.5 constituents, OC was most closely related to ED visits for pediatric asthma, and children are more vulnerable to PM2.5 and OC during cold days.
Diagnostic Pitfalls: Intramyocardial Lymphoma Metastasis Mimics Acute Coronary Syndrome in A Diffuse Large B Cell Lymphoma Patient – Case Report
Authors: Prenek Lilla , Csupor Klára , Besztercán Péter , Boros Krisztina , Kardos Erika , Vorobcsuk András , Egyed Miklós , Kellner Ádám , Rajnics Péter , Varga Csaba
Published: October 2020

Background: Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to nonspecific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis.Case presentation: 48-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock and multiple organ failure what he did not survive.Conclusions: Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.
Genetic Spectrum and Clinical Early Natural History of Glucose-6-Phosphate Dehydrogenase Deficiency in Mexican Children Detected Through Newborn Screening.
Authors: Vela-Amieva Marcela , Alcántara-Ortigoza Miguel Ángel , Angel Ariadna González del , Martínez-Belmont Leticia , López-Candiani Carlos , Ibarra-Gonzalez Isabel
Published: October 2020

Background: Glucose-6-phosphate dehydrogenase deficiency (G6PDd) newborn screening is still a matter of debate due to its highly heterogeneous birth prevalence and clinical expression as well as the lack of enough knowledge on its natural history. Herein, we describe the early natural clinical course and the underlying GDPD genotypes in infants with G6PDd detected by newborn screening and later studied in a single follow-up center. G6PDd newborns were categorized into three groups: group 1: hospitalized with or without neonatal jaundice (NNJ); group 2: nonhospitalized with NNJ; and group 3: asymptomatic. Results: A total of 81 newborns (80 males, one female) were included. Most individuals (46.9%) had NNJ without other symptoms, followed by asymptomatic (42.0%) and hospitalized (11.1%) patients, although the hospitalization of only 3 of these patients was related to G6PDd, including NNJ or acute hemolytic anemia (AHA). Nine different G6PDd genotypes were found; the G6PD A− 202A/376G genotype was the most frequent (60.5%), followed by the G6PD 376G/542T (Santamaria, 22.2%) and the Union-Maewo (rs398123546, 7.4%) genotypes. These genotypes produce a wide range of clinical and biochemical phenotypes with significant overlapping residual enzymatic activity values among class I, II or III variants. Some G6PD A− 202A/376G individuals had enzymatic values that were close to the cutoff value (5.3 U/g Hb, 4.6 and 4.8 U/g Hb in the groups with and without NNJ, respectively), while others showed extremely low enzymatic values (1.1 U/g Hb and 1.4 U/g Hb in the groups with and without NNJ, respectively). Conclusion: Wide variability in residual enzymatic activity was noted in G6PDd individuals with the same G6PD genotype. This feature, along with a documented heterogeneous mutational spectrum, makes it difficult to categorize G6PD variants according to current WHO classification and precludes the prediction of complications such as AHA, which can occur even with residual enzymatic activity (>10%) and/or be associated with the common and mild G6PD A− 376G/968C and G6PD A− 202A/376G haplotypes.
Neuropsychiatric, Cognitive and Sexual Impairment in Mastocytosis Patients
Authors: JENDOUBI Fatma , SEVERINO-FREIRE Maella , NEGRETTO Mathilde , ARBUS Christophe , PAUL Carle , Livideanu Cristina Bulai
Published: October 2020

Background: Mastocytosis is a rare disease characterised by the accumulation and/or proliferation of abnormal mast cells (MCs) in one or several organs. It may present with a number of different symptoms that involve various organ systems. The current study aims to assess the prevalence of MC mediator-related symptoms in a cohort of mastocytosis patients with a specific focus on neurological, psychiatric, cognitive and sexual symptoms. We also assessed the impact of the disease on patients’ professional lives.Patients were administered a validated multidimensional questionnaire to collect information on patients’ perception of the severity of their symptoms. From the questionnaires we extracted the neurological, cognitive, psychiatric and sexual symptoms and the impact of the disease on patients’ professional lives as well as their grading. The affective status was assessed using the 17-item version of the Hamilton Depression Rating Scale. Results: We included 139 patients. Mastocytosis was classified as systemic in 113 patients and cutaneous in 26 patients. The prevalence of MC mediator-related systemic symptoms was as follows: cutaneous (71%), gastro-intestinal (48%), cardio-vascular (36%), musculoskeletal (26.6%), fatigue (24%), urinary (14.4%) and respiratory (10%). Headaches and vertigo were noted in respectively 55% and 32% of patients. Irritability, episodes of memory loss and difficulty concentrating were reported in 54%, 52% and 40% of cases, respectively. Sexual impairment was noted in 24% of patients. No associations were found between neuropsychiatric/cognitive impairment and age, gender, diagnostic delay, disease form, the presence of cutaneous lesions, the level of serum and bone marrow tryptase and the presence of KIT mutation in bone marrow and/or skin. Depression was noted in 49% of patients. One in four patients reported a negative impact of the disease on their professional lives.Conclusions: This current study provides some insights regarding symptoms related to mastocytosis and their impact on patients’ professional lives.
Faculty Retention in Regional Medical Schools in Iran: A Qualitative Content Analysis
Authors: Shaterjalali Maria , Gholampoor Yousef , Jeihooni Ali Khani , karimi shahnaz , Mansoori Yaser , Homayounfar Reza , Ehrampoush Elham
Published: October 2020

Background and Purpose: Recruitment and retention of competent faculty members are important in maintaining and improving the quality of education and research performance of universities. The aim of the present study was to find out the faculty members’ views, experiences, and attitudes to identify the reasons for faculty attrition and retention in regional medical schools in Iran.Methods: In this qualitative study, we used a content analysis method. The participants included 12 faculty members who had been transferred to type I universities, four faculty members applying for transfer, four with more than ten years of experience and working in the universities of small cities without any application for transfer. Data were collected using semi-structured interviews, which were conducted either face-to-face or via phone calls. To measure the trustworthiness of the data, we evaluated four components of credibility, transferability, dependability, and confirmability, proposed by Lincoln and Guba.Results: The findings were classified into three categories and 14 subcategories. The first category was “retention facilitators” including four subcategories of facilitated communication, proximity to major universities, gaining experience, and support by authorities. The second category was “retention threats” including six subcategories of social infrastructure, individual dimension, occupation dimension, economic dimension, sense of respect, and executive management. The third category was “retention strategies” which included four subcategories of employment and promotion processes, inter-university collaboration with type I universities, facilitation of the scientific growth, and fulfilment of the safety needs.Conclusion: Several factors play a role in the faculty members’ retention in regional medical schools. Authorities can create a more positive environment by devising a suitable reward system, supporting academic activities, and increasing the level of practical faculty autonomy to develop a sense of belonging among them and reduce the intention to transfer among their human resources.
A New OXA-66-harboring Acinetobacter Baumannii Sub-Clonal Complex 195 is Spreading Widely in Guangzhou, China, A Multicenter Study
Authors: Li Yujun , Huang Xiaomei , Wang Yuyao , Pan Chuzhi , Mo Zexun , Huang Muchao , Fang Changquan , Guo Penghao , Chen Huiling , Zhao Ziwen , Wei Shuquan
Published: October 2020

Objectives The clonal spread of Acinetobacter baumannii (A. baumannii) is an emerging problem. We analyzed the molecular epidemiology of A. baumannii isolated from 5 teaching hospitals in Guangzhou, China. Methods 138 A. baumannii isolates were collected. Multilocus sequence typing (MLST) was used to assess the genetic relationships among the isolates. The blaOXA-51-like gene was amplified and then sequenced. Results Most of the isolates (55.8%, 77/138) were obtained from intensive care units (ICUs). The respiratory system was the most common site where A. baumannii was found (72.5%, 100/138). A. baumannii remained susceptible to polymyxin and tigecycline, but the susceptibility to other antimicrobial agents was below 30%. We used MLST to group the A. baumannii isolates into 8 existing sequence types (STs) and 17 new STs. With the predicted founder ST195 (accounted for 35.5% of all isolates, 49/138), Clonal complex (CC) 195 was the most prevalent and widely spread STs in the hospital environment. All ST195 isolates harbored OXA-66 according to the blaOXA-51-like gene sequencing. But each hospital had its unique epidemiological feature. Conclusions OXA-66 gene harboring CC195 was the most epidemic STs in Guangzhou, China. Health care facilities should develop their own management strategy.
Biofilm Formation and Antibiotic resistance of Enterobacteriaceae isolates from Surgical Site infections in Hôpital de Référence Saint Joseph, Kinshasa, Democratic Republic of Congo
Authors: Iyamba Jean-Marie Liesse , Mabankama Rodriguez Musomoni , Lukukula Cyprien Mbundu , Unya Joseph Welo , Okombe Daniel Tassa , Ngbandani Benjamin Kodondi , Vihembo Grégoire Mbusa , Ngoma Nelson Nsiata , Kajinga Thierry Mukendi , Mapipi Odette Mboma , Kasongo Jacques Onokodi , Takaisi-Kikuni NB
Published: October 2020

Background: Enterobacteriaceae are one of the most predominant pathogen in surgical site infections. In recent years we oberved increase in resistance among bacteria from surgical site infections. The aim of this study was to evaluate antimicrobial suceptibility pattern of Enterobacteriaceae isolates from surgical site infections, the biofilm formation and the production of OXA-48 carbapenemase.Methods: A total of 41 Enterobacteriaceae (19 Escherchia coli, 8 Enterobacter sp., 9 Citrobacter sp., and 5 Serratia sp. ) clinical isolates were collected from patients with SSI in Hôpital Saint Joseph (Kinshasa) for diagnostic purposes. The pus samples were cultured and the antibiotic susceptibility profile of the isolates were determined by disk-diffusion method following Clinical and Laboratory Standards Institute 2012 recommendations. OXA-48-producing Enterobacteriaceae were detected using ChromaticTM OXA-48 chromogenic medium. Crystal Violet Staining Method was used to assess the ability of bacteria strains to form a biofilm. Results: All Enterobacteriacea isolates studied were biofilm producers and highly resistant to the majority of antibiotics tested. E. coli, Enterobacter sp., Citrobacter sp., and Serratia sp. were 100 % resistant cefotaxime, imipenem, and amoxicillin-clavulanic acid, and ampicillin. Serratia sp. isolates were 100% and 80% sensitive to norfloxacine and amikacine respectively. There was relationship between antibiotic resistance and biofilm production. E. coli, Enterobacter sp., and Citrobacter sp. strains were all OXA-48 producers.Conclusion: The results of the present study demonstrate the emergence of multidrug resistant organisms, the correlation between antibiotic resistance- biofilm formation and OXA-48 production. These results suggest the implementation of antimicrobial resistance survey programm in order to prevent and combat the spread of multidrug resistant organisms in hospital and community in Democratic Republic of Congo.