bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study of multimodal magnetic resonance in the differential diagnosis of acquired immune deficiency syndrome related primary central nervous system lymphoma and infection
Authors: Li Jingjing , Xue Ming , Yan Shuo , Guan Chunshuang , Xie Ruming , Chen Budong
Published: November 2020

Background: Patients with acquired immune deficiency syndrome (AIDS) often suffer from opportunistic infections and related primary central nervous system lymphoma(AR-PCNSL). Both diseases showed multiple ring enhancement lesions in conventional magnetic resonance (MR). It is very difficult to make the differential diagnosis. We aimed to investigate whether multimodal MR can differentiate AR-PCNSL from infection. Methods: This was a prospective study. We recruited 19 AIDS patients who were divided into AR-PCNSL group (9 cases) and infection group (10 cases) by pathological results. We analyzed whether there was statistical(Fisher’s method) difference in multimodal MR between the two groups Results: The lesion were more likely involved the paraventricular (0.020) and corpus callosum (0.033) in AR-PCNSL group in conventional MR. In multimodal MR, AR-PCNSL group showed low apparent diffusion coefficient (ADC) value, with p values of 0.001. Infection group more inclined to high ADC value, with p was 0.003. In multimodal MR, AR-PCNSL group had more low signal intensity(grade 2-3) in the degree of intratumoral susceptibility signal intensity in susceptibility weighted imaging(SWI-ITSS) ,with p values of 0.001. The sensitivity, specificity of conventional MR in the diagnosis of AR-PCNSL were 88.9%, and 70.0%. The conventional MR sequence combined with the diffusion weighted image (DWI)/ADC sequence in the diagnosis of AR-PCNSL had a sensitivity of 100.0%, and a specificity of 60.0%. The sensitivity and specificity of the conventional MR sequence combined with the SWI-ITSS sequence in the diagnosis of AR-PCNSL were 100% and 70.0%. The conventional MR combined with ADC or SWI-ITSS improved the diagnosis of AR-PCNSL. Conclusion: The multimodal MR could improve the diagnosis of AR-PCNSL. We recommend DWI sequence in all AIDS patients with brain focal lesions. When distinguishing AR-PCNSL from toxoplasmosis or tuberculoma, SWI should be used to obtain a correct diagnosis.
Molecular epidemiology of SARS-CoV-2 clusters caused by asymptomatic cases in Anhui Province, China
Authors: yuan yuan , He Jun , Gong Lei , Li Weiwei , Jiang Liangliang , Liu Jiang , Chen Qingqing , Yu Junling , Hou Sai , Shi Yonglin , Lu Siqi , Zhang Zhuhui , Ge Yinglu , Sa Nan , He Lan , Wu Jiabing , Sun Yong , Liu Zhirong
Published: November 2020

Background: COVID-19 is a newly emerging disease caused by a novel coronavirus (SARS-CoV-2), which spread globally in early 2020. Asymptomatic carriers of the virus contribute to the propagation of this disease, and the existence of asymptomatic infection has caused widespread fear and concern in the control of this pandemic. Methods: In this study, we investigated the origin and transmission route of SARS-CoV-2 in Anhui’s two clusters, analyzed the role and infectiousness of asymptomatic patients in disease transmission, and characterized the complete spike gene sequences in the Anhui strains. Results: We conducted an epidemiological investigation of two clusters caused by asymptomatic infections sequenced the spike gene of viruses isolated from 12 patients. All cases of the two clusters we investigated had clear contact histories, both from Wuhan, Hubei province. The viruses isolated from two outbreaks in Anhui were found to show a genetically close link to the virus from Wuhan. In addition, new single nucleotide variations were discovered in the spike gene. Conclusions: Both clusters may have resulted from close contact and droplet-spreading and asymptomatic infections were identified as the initial cause. We also analyzed the infectiousness of asymptomatic cases and the challenges to the current epidemic to provided information for the development of control strategies.
An Outbreak of Gastroenteritis Associated with a Novel GII.8 Sapovirus Variant-Transmitted by Vomit in Shenzhen, China, 2019
Authors: Yan Yuxiao , Li Yuan , Wen Shi , Kong Xiangyu , LI Huiying , Zhang Qing , Pang Lili , Jiang Li , Liu Junying , Jin Miao , Li Yuning , Duan Zhaojun
Published: November 2020

BackgroundHuman Sapoviruses (SaVs) has been reported as one of the causative agents of acute gastroenteritis (AGE) worldwide. An outbreak of SaVs affected 482 primary school students during spring activities from February 24 to March 11, 2019 in Shenzhen City, China. Our study was aimed at determining the epidemiology of the outbreak, investigating its origins, and making a clear identification of the SaVs genetic diversity.MethodsEpidemiological investigation was conducted for this AGE outbreak. Stool samples were collected for laboratory tests of causative agents. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) and conventional RT-PCR were used for detecting and genotyping of SaVs. The nearly complete genome of GII.8 SaV strains were amplified and sequenced by using several primer sets designed in this study. Phylogenetic analysis was performed to characterize the genome of GII.8 SaV strains.ResultsThe single factor analysis showed that the students who were less than 1.5 meters away from the vomitus in classroom or playgroundwere susceptible (P < 0.05). Seven of eleven fecal samples from patients were positive for GII.8 SaV genotype. In this study, we obtained the genome sequence of a SaV GII.8 strain Hu/SaV/2019008Shenzhen/2019 /CHN (SZ08)and comprehensively analyzed the genetic diversity. The phylogenetic analysis showed that the GII.8 strain SZ08 formed an independent branch and became a novel variant of GII.8 genotype. Strain SZ08 harbored 11 specific amino acid variations compared with cluster A-D in full-length VP1. ConclusionsThis study identified SaVs as the causative agents for the AGE outbreak. Strain Hu SZ08 was clustered as independent branch and there was no recombination occurred in this strain SZ08. Further, it might become the predominant strain in diarrhea cases in the near future. Constant surveillance is required to monitor the emerging variants which will improve our knowledge of the evolution of SaVs among humans.
The potential role of serum angiotensin-converting enzyme in coronavirus disease 2019
Authors: Zhu Zhe , Cai Ting , Fan Lingyan , Lou Kehong , Hua Xin , Huang Zuoan , Gao Guosheng
Published: November 2020

Background To explore the clinical significance of serum angiotensin-converting enzyme (ACE) activity in coronavirus disease 2019 (COVID-19).Methods In this retrospective study, a total of 136 consecutive patients with confirmed COVID-19 were recruited. Demographic and clinical data were recorded. The serum ACE activity was measured at baseline and during the recovery phase, and its relationship with clinical condition was analyzed.Results Of the 136 patients with confirmed COVID-19, the 16 severe patients were older and had a higher body mass index (BMI) and proportion of hypertension than the 120 nonsevere patients. In comparison to those of normal controls, the baseline serum ACE activities of subjects in the severe group and nonsevere group were decreased, with the lowest level in the severe group. However, the serum ACE activity increased in the recovery phase, and there were no significant differences among the severe group, nonsevere group and normal control group.Conclusion Serum ACE activity could be used as a marker to reflect the clinical condition of COVID-19 since low activity was associated with the severity of COVID-19 at baseline, and the activity increased with the remission of the disease.
Effectiveness of Interventions on Early Neurodevelopment of Preterm Infants: A Systematic Review and Meta-Analysis
Authors: Aita Marilyn , Clifford-Faugère Gwenaëlle De , Lavallée Andréane , Feeley Nancy , Stremler Robyn , Rioux Emilie , Proulx Marie-Hélène
Published: November 2020

Background: As preterm infants’ neurodevelopment is shaped by NICU-related factors during their hospitalization, it is essential to evaluate which interventions are more beneficial for their neurodevelopment at this specific time. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of interventions initiated during NICU hospitalization on preterm infants’ early neurodevelopment during their hospitalization and up to two weeks corrected age (CA). Methods: This systematic review referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO (CRD42017047072). We searched CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Systematic Reviews, CENTRAL, and Web of Science from 2002 to February 2020 and included randomized controlled/clinical trials conducted with preterm infants born between 24 and 366/7 weeks of gestation. All types of interventions instigated during NICU hospitalization were included. Two independent reviewers performed the study selection, data extraction, assessment of risks of bias and quality of evidence. Results: Findings of 12 studies involving 901 preterm infants were synthesized. We combined three studies in a meta-analysis showing that compared to standard care, the NIDCAP intervention is effective in improving preterm infants’ neurobehavioral and neurological development at two weeks CA. We also combined two other studies in a meta-analysis indicating that parental participation did not significantly improve preterm infants’ neurobehavioral development during NICU hospitalization. For all other interventions (i.e., developmental care, sensory stimulation, music and physical therapy), the synthesis of results shows that compared to standard care or other types of comparators, the effectiveness was either controversial or partially effective. Conclusions: The overall quality of evidence was rated low to very low. Future studies are needed to identify interventions that are the most effective in promoting preterm infants’ early neurodevelopment during NICU hospitalization or close to term age. Interventions should be appropriately designed to allow comparison with previous studies and a combination of different instruments could provide a more global assessment of preterm infants’ neurodevelopment and thus allow for comparisons across studies. Systematic Review Protocol Registration: Prospero CRD42017047072
Characteristics and prognostic factors of COVID-19 among infected cases: A nationwide Tunisian analysis
Authors: harizi chahida , Cherif Ines , Najar Nourhene , Osman Molka , Mallekh Rym , Ayed Oumaima Ben , Ayedi Yosr , Dhaouadi Sonia , Hchaichi Aicha , Safer Mouna , Letaief Hejer , Bouaziz Ilhem , Derouiche Sondes , Bouabid Leila , Bougatef Souha , Gharbi Donia , Salah Hamida Ben , Fakhfakh Radhouane , Abid Salma , Boubaker Ilhem Boutiba Ben , Chahed Mohamed Kouni , Ben-Alaya Nissaf Bouafif
Published: November 2020

Background: The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Few data are available on the duration and prognostic factors of the disease. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify the prognostic factors.Methods: A retrospective, nationwide study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognostic factors.Results: One thousand thirty patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 141 (14.8%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among 827 patients who didn’t require specialized care, 55.5% were self-isolated at home, while the rest were in specialized centers. Six hundred two patients were symptomatic. A total of 634 (61.6 %) patients have recovered and 45 (4.4 %) patients died. The median duration of illness was estimated to be 31 days (95% CI: [29 - 32]). Older age (HR=0.66, CI:[ 0.46-0.96], P=0.031) and symptoms (HR=0.61, CI:[ 0.43-0.81], P=0.021) were independently associated with a delay in recovery time. Being a healthcare professional (HR=1.52, CI :[1.10-2.08], P=0.011) and patients in home isolation compared to isolation centers (HR=2.99, CI :[1.85-4.83], P<10¯³) were independently associated with faster recovery time. Conclusion: The duration of illness was estimated to be one month. However, this long estimated duration of illness may not equate to infectiousness. A particular attention must to be paid to elderly and symptomatic patients with closer monitoring.
Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study
Authors: Cattelan Anna Maria , Meco Eugenia Di , Trevenzoli Marco , Frater Alessia , Ferrari Anna , Villano Marco , Gomiero Federica , Carretta Giovanni , Sasset Lolita
Published: November 2020

Background Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not.Methods This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups. Results 303 patients were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p<0.01), had a higher fatality rate (14.5% vs. 3.8%, p<0,01), had more hypertension (72.4% vs. 44%, p<0,01) and diabetes (31.9% vs. 21%, p=0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p<0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p=0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-reactive-protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-reactive-protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p<0.01). Conclusions The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.
Development of a Managed Clinical Network for Children’s Palliative Care – A Qualitative Evaluation
Authors: Papworth Andrew , Fraser Lorna , Taylor Jo
Published: November 2020

BackgroundConsistent evidence suggests that children’s palliative care is not equitable and managed clinical networks (MCNs) have been recommended as a solution. This study explored the perspectives of health professionals involved in the development of a children’s palliative care MCN, with an aim to identify barriers and enablers of successful implementation.MethodsThematic analysis of semi-structured interviews and focus groups with 45 healthcare staff with a role in developing the MCN or in the delivery of children’s palliative care (September 2019-March 2020). ResultsThe study explored health professionals’ perceptions of the MCN features that helped to formalise governance processes, establish training and networking opportunities, standardise practice, and improve collaboration between organisations. These include the funded MCN co-ordinator, committed individuals who lead the MCN, and a governance structure that fosters collaboration. However, the MCN’s development was impeded by cross-cutting barriers including limited funding for the MCN and children’s palliative care more generally, no shared technology, lack of standards and evidence-base for children’s palliative care, and shortage of palliative care staff. These barriers impacted on the MCN’s ability to improve and evaluate palliative care provision and affected member engagement. Competing organisational priorities and differences between NHS and non-NHS members also impeded progress. Training provision was well received, although barriers to access were identified. ConclusionsKey features of children’s palliative care can act as barriers to developing a managed clinical network. Managing expectations and raising awareness, providing accessible and relevant training, and sharing early achievements through ongoing evaluation can help to sustain member engagement, which is crucial to a network’s success.
“Brought to life through imagery” – Animated graphic novels to promote empathic, patient-centred care in postgraduate medical learners
Authors: Sutherland Travis , Choi Dorothy , Yu Catherine
Published: November 2020

Background: Empathy levels decline through medical training. This has been associated with poor patient and physician outcomes, and strategies to combat this decline are increasingly recognized as critical aspects of medical education. The aim of this study was to qualitatively determine factors associated with empathy decline, and to assess the impact of a comics/graphic novel-based curriculum on enhancing empathy and a patient-centered approach to care in post-graduate medical learners. Methods: Fourth and fifth year residents in the Adult and Pediatric Endocrinology and Metabolism Program at the University of Toronto were recruited from the 2017 cohort of the Empathy, Humanism & Comics course. Participants completed a 12-month curriculum, viewing a total of four animated graphic novels over six sessions. At the end of the course participants were interviewed either individually or in a focus group. A coding framework of emerging themes was developed based on consensus between the three authors using a qualitative descriptive approach and the constant-comparison method.Results: Analysis of coded interview data revealed four themes. 1. The curriculum accurately reflected and addressed issues in real world medical practice; 2. The comics curriculum facilitated holistic development; 3. Participants appreciated the comics as an educational medium; 4. Participant feedback on the curriculum. The importance of empathy was noted, while participants acknowledged their own empathy decline and increased burnout. Stressors included increasing responsibility, long work hours, and competing work-life responsibilities. They felt the sessions developed resilience, an appreciation for the patient perspective, and communication skills. They appreciated the comics as a novel and engaging educational modality. Feedback on the effectiveness and relevancy of the curriculum was variable.Conclusions: Residents appreciated sharing difficult experiences and seeking support. They acknowledged the curriculum as a commitment to wellness and felt it reduced burnout and improved empathy. The comics were viewed as an effective reminder of the patient perspective. Variable curriculum feedback highlights the challenge in designing a course for adult learners. Future investigations may include the development and incorporation of similar curricula in other post-graduate residency training programs.
Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak
Authors: Wang Zhigang , Wang Zhiqiang
Published: November 2020

Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the central Hospital of Wuhan from January 29, 2020, to March 20, 2020 and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results and disease outcomes were collected and analyzed. Results: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea and fatigue. Compared to survival cases, patients who dead during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received anti-biotics and anti-viral treatment. In addition, 60 patients received corticosteroid and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]) and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]=1.098, 95% CI [confidence interval]: 1.006-1.199, P=0.037), shorter duration from onset to admission (OR= 0.853, 95% CI: 0.750-0.969, P=0.015) and elevated lactate level upon admission (OR= 2.689, 95% CI: 1.044-6.926, P=0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.787, 95% CI: 0.686-0.903, P=0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, duration from onset to admission, LYM (%) and lactate level upon admission were independent factors that affecting in-hospital mortality rate.
Catheter Care Bundle and Low Catheter Related Bloodstream Infection Rates in a Home Parenteral Nutrition Population; a  4 Year Observational Study
Authors: DeLegge Mark , Hamilton Karen Sexton , Leone Melissa , Checkley L. Allyson
Published: November 2020

Home Parenteral Nutrition (HPN) is often a life-saving therapy for patients. One of the most common complications for HPN is catheter-related blood stream infections (CRBSI). In the home setting there is no single defined “care bundle” for the on-going maintenance of central venous catheters (CVC) for the prevention of CRBSI. We evaluated the impact of a standardized catheter care bundle in patients receiving HPN on the incidence of CRBSI. Methods: Data collection included use of standardized tools and processes to capture patient demographics, catheter complications including CRBSI and some associated risk factors. Reported data was collected and analyzed annually and compared year-to-year from the years 2014-2017 from one national home infusion company. CRBSI reported as number of infections/1000 catheter days Results: The CRBSI rate/1000 days was reported as 0.43, 0.31, 0.30 and 0.23 (2014, 2015, 2016, 2017 respectively) statistically significant difference (p < .05) between the years 2014 and 2017. CRBSI. Conclusion: The use of a catheter care bundle in an HPN population may have contributed to a 4- year reported outcomes of low and continuously declining CRBSI in a large, diverse United States-based HPN population.
Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis
Authors: Yu Dongwoo , Kim Sang Woo , Jeon Ikchan
Published: November 2020

Background: There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO.Methods: A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups.Results: Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p=1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194).Conclusions: The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.
Cognitive Functioning in Deaf Children Using Cochlear Implants
Authors: Almomani Fidaa , Almomani Murad O , Alqudah Safa , Garadat Soha , Kassab Manal , Hamadneh Shereen , Rauterkus Grant , Gans Richard
Published: November 2020

BACKGROUND: Cognitive abilities like language, memory, reasoning, visualization, and perceptual functioning shape human action and are considered critical to the successful interaction with the environment. Alternatively, hearing loss can disrupt a child’s ability to communicate, and negatively impact cognitive development. Cochlear implants (CI) restore auditory input thereby supporting communication and may enhance cognitive performance. This study compares general cognitive development after cochlear implantation in two groups of children implanted earlier (age:4-6 years, N=22) and later (7-9 years, N=16) to the development of randomly selected normal hearing peers (N=48).DESIGN: Visualization, reasoning, memory, and attention were assessed using the Leiter-R scale at baseline (before implantation), 8 months and 16 months post implantation for children with hearing loss. Same times of testing (baseline, 8 months and 16 months) were used for normal hearing peers. RESULTS: Over the 16-month period, the cognitive improvement of 4-6 year old deaf children was greater than that of their normal hearing peers on all scales except for attention, while the improvement of 7-9 year old was less major than that of their normal hearing peers on all scales. CONCLUSIONS: These results suggest that CI not only enhances communication skills but may improve cognitive functioning in deaf children. However, the extent of this improvement was dependent on age at intervention; current results demonstrated that the children received CI at young ages had better cognitive improvements.
What impact does postgraduate clinical training have on empathy among Japanese trainee dentists?
Authors: Yoshida Toshiko , Watanabe Sho , Kono Takayuki , Taketa Hiroaki , Shiotsu Noriko , Shirai Hajime , Nakai Yukie , Torii Yasuhiro
Published: November 2020

Background: Enhancing empathy in healthcare education is a critical component in the development of a relationship between healthcare providers and patients that would ensure better patient care; improved patient satisfaction, adherence to treatment, patients’ medication self-efficacy, improved treatment outcomes, and reduced patient anxiety. Unfortunately, however, the decline of empathy among students has been frequently reported. It is especially common when the curriculum transitions to a clinical setting. However, some studies have questioned the significance and frequency of this decline. Thus, the purpose of this study was to determine the impact of postgraduate clinical training on dental trainees’ empathy from cognitive, behavioral, and patients’ perspective.Methods: This study included 64 trainee dentists at Okayama University Hospital and 13 simulated patients (SPs). The trainee dentists carried out initial medical interviews with SPs twice, at the beginning and the end of their clinical training. The trainees completed the Japanese version of the Jefferson Scale of Empathy for health professionals just before each interview. The SPs evaluated the trainees’ communication using an assessment questionnaire immediately after the interviews. All interviews were videotaped and analyzed using the Roter Interaction Analysis System. The hypothesis was that empathy in the trainees would have reduced at the end of their clinical training. The results were compared between the beginning and the end. The data were analyzed utilizing paired t-test and the Wilcoxon signed-ranks test.Results: No significant difference was found in the self-reported empathy of trainees at the beginning and the end of the clinical training (107.73 vs. 108.34, p=0.643). Similarly, there was no difference in the SPs’ evaluation of trainees’ communication (10.73 vs. 10.38, p=0.434). Communication behavior in the emotional responsiveness category for trainees in the beginning was significantly higher than that at the end (2.47 vs. 1.14, p=0.000).Conclusions: Overall, a one-year postgraduate dental training program neither reduced nor increased trainee dentists’ empathy levels. Providing regular education support in this area may help trainees foster their empathy.
Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: A retrospective study from Wuhan, China
Authors: Xiao Jianwei , Li Xiang , Xie Yuanliang , Huang Zengfa , Ding Yi , Zhao Shengchao , Yang Pei , Du Dan , Liu Bin , wang xiang
Published: November 2020

Background: The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms. Methods: This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID­19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression.Results: Patients with severe/critical symptoms were older (p<0.001) and more often male (p=0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (>11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811-0.902).Conclusions: Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (>11) was associated with severe illness.
The bibliometric landscape of infectious disease research in Panama (1990 - 2019): An evaluation of the country’s capability on One Health
Authors: Loaiza Jose , Zapata Robinson , Kosagisharaf Rao , Gittens Rolando A. , Mendoza Enrique , Sanjur Oris I. , Urrutia Víctor Sánchez , Romero Luz I. , Franco Leticia , Armien Blas , González-Santamaría José , Ortega-Barría Eduardo
Published: November 2020

Background: This work aims to analyze the landscape of scientific publications on subjects related to One Health and infectious diseases in Panama. Methods: Boolean searches on the Web of Science, SCOPUS and PubMed were undertaken to evaluate the main trends of publications related to One Health and infectious disease research in the country of Panama, between 1990 and 2019. Results: 4,547 publications were identified since 1990, including 3,564 peer-reviewed articles interconnected with One Health related descriptors, and 211 articles focused particularly on infectious diseases. There was a pattern of exponential growth in the number of publications with various contributions from Panamanian institutions. The rates of multidisciplinary, inter-institutional and inter-sectoral research ranged from moderate to low, to very low, respectively. Research efforts have centered largely on protozoan, neglected and arthropod-borne diseases with a strong emphasis on malaria, Chagas and leishmaniasis. Conclusion: Panama has scientific capabilities on One Health to tackle future infectious disease threats, but the official collaboration schemes and strategic investment to develop further competencies need to be considered. Through future collaborative efforts, Panama can reduce the risk of pandemics by developing surveillance strategies to improve the prediction of disease spillover, spread and persistence while helping to mitigate the impact on public health and the economy, regionally.
Establishing percentiles for blood pressure based on absolute height for children and adolescents
Authors: Cossio-Bolaños Marco , Vidal-Espinoza Ruben , de Campos Felipe Castelli Correia , Sulla-Torres Jose , Cossio-Bolaños Wilbert , Andruske Cynthia , Urra-Albornoz Camilo , Gomez-Campos Rossana
Published: November 2020

Background: Evaluating blood pressure (BP) is one element for diagnosing and preventing disease in student populations. The objectives of this research were to a) identify the range of height for measuring BP adjusted for student populations and b) propose percentiles for evaluating BP based on height.Methods: A cross-sectional study was carried out with 3,013 students. Weight, height, and diastolic (DBP) and systolic (SBP) blood pressure were evaluated. Body Mass Index (BMI) was calculated. Height ranges of 5 and 10 cm were generated.Results: R2 values for height ranges of 5 cm consisted of [normotensive: DBP (R2=10 to 13%) and SBP (R2=14 to 20%), and for hypertensive: DBP (R2=0.07 to 15%) and for SBP (R2=29 to 32%)]. For height ranges of 10cm, values included: [normotensive: DBP (R2=10 to 15%), and SBP (R2=15 to 21%) and for hypertensive: DBP (R2= 0.07 to 16%) and SBP (R2=29 to 35%)]. For 5 cm height ranges, diferences occurred between both sexes for DBP (in 5 height ranges from 123 to 148 cm and 158 to 168 cm) and for the SBP (in 6 height ranges from 128 to 148 cm and from 158 to 168 cm). In the 10 cm categories, diferences appeared in DBP (from 138 to 148 cm) and in the SBP (from 158 to 168 cm).Conclusion: Height is a determinant for evaluating blood pressure, and height ranges of 10 cm are more suitable for children and adolescents. The proposed percentiles based on height ranges allowed assessment of the DBP and SBP suggest their use in epidemiological and educational contexts.
Spatial transmission network construction of influenza-like illness using Dynamic Bayesian Network and Vector-Autoregressive Moving Average Model
Authors: Qiu Jianqing , Wang Huimin , Hu Lin , Yang Changhong , Zhang Tao
Published: November 2020

Background: Although vaccination is one of the main countermeasures against influenza epidemic, it is highly essential to make informed prevention decisions to guarantee that limited vaccination resources are allocated to the places where they are most needed. Hence, one of the fundamental steps for decision making in influenza prevention is to characterize its spatio-temporal trend, especially on the key problem about how influenza transmits among adjacent places and how much impact the influenza of one place could have on its neighbors. To solve this problem while avoiding too much additional time-consuming work on data collection, this study proposed a new concept of spatio-temporal route as well as its estimation methods to construct the influenza transmission network.Methods: The influenza-like illness (ILI) data of Sichuan province in 21 cities was collected from 2010 to 2016. A joint pattern based on the dynamic Bayesian network (DBN) model and the vector autoregressive moving average (VARMA) model was utilized to estimate the spatio-temporal routes, which were applied to the two stages of learning process respectively, namely structure learning and parameter learning. In structure learning, the first-order conditional dependencies approximation algorithm was used to generate the DBN, which could visualize the spatio-temporal routes of influenza among adjacent cities and infer which cities have impacts on others in influenza transmission. In parameter learning, the VARMA model was adopted to estimate the strength of these impacts. Finally, all the estimated spatio-temporal routes were put together to form the final influenza transmission network.Results: The results showed that the period of influenza transmission cycle was longer in Western Sichuan and Chengdu Plain than that in Northeastern Sichuan, and there would be potential spatio-temporal routes of influenza from bordering provinces or municipalities into Sichuan province. Furthermore, this study also pointed out several estimated spatio-temporal routes with relatively high strength of associations, which could serve as clues of hot spot areas detection for influenza surveillance.Conclusions: This study proposed a new framework for exploring the potentially stable spatio-temporal routes between different places and measuring specific the sizes of transmission effects. It could help making timely and reliable prediction of the spatio-temporal trend of infectious diseases, and further determining the possible key areas of the next epidemic by considering their neighbors’ incidence and the transmission relationships.
Critically ill patients with diabetes and Middle East respiratory syndrome: A multi-center observational study
Authors: Jose Jesna , Al-Dorzi Hasan , Al-Omari Awad , Mandourah Yasser , Al-Hameed Fahad , Sadat Musharaf , Al-Qasim Eman , Alraddadi Basem , Harthy Abdulrahman Al , Mekhlafi Ghaleb A Al , Almotairi Abdullah , Khatib Kasim Al , Abdulmomen Ahmed , Qushmaq Ismael , Sindi Anees , Mady Ahmed , Solaiman Othman , Al-Raddadi Rajaa , Maghrabi Khaled , Rajab Ahmed , Kharaba Ayman , Shalhoub Sara , Al-Aithan Abdulsalam M , Vishwakarma Gajendra K , Bhattacharjee Atanu , Arabi Yaseen
Published: November 2020

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012- January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p<0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18-3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.
Covid-19 in South America: Clinical and epidemiological characteristics among 381 patients during the early phase of the pandemic in Santiago, Chile
Authors: Rodriguez Macarena , Peters Anne , Perez Inia , Spencer Maria , Barbe Mario , Porte Lorena , Weitzel Thomas , Aylwin Mabel , Vial Pablo , Araos Rafael , Munita Jose M
Published: November 2020

Background: Understanding the characteristics of the Covid-19 pandemic in different geographical regions, ethnic and socioeconomic settings are of emerging importance. This study presents the demographic and clinical features of SARS-CoV-2 infected patients in a large private healthcare center in Santiago, Chile, during the first month of the pandemic.Methods: We analyzed the demographics, laboratory and clinical characteristics including severity and outcome of all patients diagnosed with Covid-19 during the first month of the pandemic. SARS-2-CoV infection was confirmed by RT-PCR in nosopharyngeal samples. The primary outcome was a composite of ICU admission or all-cause, in-hospital mortality. Clinical and laboratory parameters of hospitalized patients were analyzed regarding their association with the primary outcome. Results: From March 3 to April 4, 2020, 3679 individuals were tested for SARS-CoV-2 in our hospital. Of those, 381 had Covid-19 and were included into this analysis. Most patients (99.2%) were Chileans, 12% returning from recent travel. The median age was 39 years (IQR 31-49) and 52% were female. A total of 88 patients (23.1%) were hospitalized; 18 (3.7%) required ICU and/or died. The overall mortality was 0.7%. Increased body mass index (BMI) and elevated C-reactive protein (CRP) were independently associated with ICU care or death.Conclusion: During the first weeks of the pandemic in Chile, most Covid-19 patients were young, with low rates of hospitalization, ICU requirement, and fatality. BMI and CRP on admission were predictors for severity. Our data provide important information on the clinical course and outcome of Covid-19 in a Latin American setting.
Visual short-term memory impairments in presymptomatic familial Alzheimer’s disease: A longitudinal observational study
Authors: Pavisic Ivanna M. , Nicholas Jennifer M. , Pertzov Yoni , O'Connor Antoinette , Liang Yuying , Collins Jessica D. , Lu Kirsty , Weston Philip S.J. , Ryan Natalie S. , Husain Masud , Fox Nick C. , Crutch Sebastian J.
Published: November 2020

Visual short-term memory (VSTM) deficits including VSTM binding have been associated with Alzheimer’s disease (AD) from preclinical to dementia stages, cross-sectionally. Yet, longitudinal investigations are lacking. The objective of this study was to evaluate VSTM function longitudinally and in relation to expected symptom onset in a cohort of familial Alzheimer’s disease. Ninety-nine individuals (23 presymptomatic; 9 symptomatic and 67 controls) were included in an extension cross-sectional study and a sub-sample of 48 (23 presymptomatic carriers, 6 symptomatic and 19 controls), attending two to five visits with a median interval of 1.3 years, included in the longitudinal study. Participants completed the “What was where?” relational binding task (which measures memory for object identification, localisation and object-location binding under different conditions of memory load and delay), neuropsychology assessments and genetic testing. Compared to controls presymptomatic carriers within 8.5 years of estimated symptom onset, had a faster rate of decline in localisation performance in long-delay conditions (4 seconds) which preceded changes in traditional neuropsychology. This represents the first longitudinal VSTM investigation and shows that changes in memory resolution may be sensitive to tracking cognitive decline in preclinical AD.
Associated risk factors with disease severity and antiviral drug therapy in patients with COVID-19 
Authors: Gong Xiaowei , Guo Xianfeng , Kang Shiwei , Li Yan , Gao Haixiang , Yuan Yadong
Published: November 2020

Background: Due to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with increased COVID-19 severity and evaluate the current antiviral drugs, especially in severe patients. Methods: This was a retrospective observational study performed at the No. 7 Hospital of Wuhan (Wuhan, China) with hospitalized patients confirmed with COVID-19 from January 11 to March 13, 2020. Multivariable logistic regression analysis was used to identify the associated factors of severe COVID. Treatments of antivirus drugs were collected and evaluated.Results: Of the 550 patients, 292 (53.1%) were female and 277 (50.4%) were >60 years old. The most common symptom was fever (n=372, 67.7%), followed by dry cough (n=257, 46.7%), and dyspnea (n=237, 43.1%), and fatigue (n=224, 40.7%). Among the severe patients, 20.2% required invasive ventilator support and 18.0% required non-invasive ventilator. The identified risk factors for severe cases were: age ≥60 years (odds ratio (OR) =3.02, 95% confidence interval (CI): 1.13-8.08, P=0.028), D-dimer >0.243 μg/ml (OR=2.734, 95%CI: 1.012-7.387, P=0.047), and low oxygenation index (OR=0.984, 95%CI: 0.980-0.989, P<0.001). In severe cases, the benefits (relief of clinical symptoms, clinical outcome, and discharge rate) of arbidol alone was 73.3%, which was better than ribavirin (7/17, 41.2%, P=0.029).Conclusions: Age >60 years, D-dimer >0.243 µg/ml, and lower oxygenation index were associated with severe COVID-19. Arbidol might provide more clinical benefits in treating patients with severe COVID-19 compared with ribavirin.
Transmission of Synovial Sarcoma from A Single Multiorgan Donor to Three Transplant Recipients: Cases Report and Literature Review
Authors: Zhang Jian , Tian Ye , Yang Yang , Xu Ruifang , Lin Jun
Published: November 2020

Background Donor-derived malignancy is sometimes unidentified at the time of transplantation, resulting in unanticipated donor-derived malignancy, which becomes a notable problem since the increasing use of marginal donors. Case presentation We first report three cases of donor-derived synovial sarcoma from a single multiorgan donor in China. The donor was died of respiratory failure caused by an intrathoracic tumor, which was diagnosed as a benign tumor at the time of donation. All of the three recipients developed synovial sarcoma within 3 months to 13 months after transplantation, proven to be donor-derived. Liver transplant recipient died of tumor metastasis. Two kidney transplant recipients survived from metastases by comprehensive therapy, including the first use of Anlotinib, exhibiting an effective anti-tumor activity.Conclusions This report highlights the importance of detailed donor assessment, close follow-up and timely treatment, as well as the need for establishing a post-transplant surveillance system for donor-derived transmission events. Whether to use organs from a donor with initial diagnosis of benign tumor needs to be cautious. Malignant potential of tumors needs to be excluded before transplantation, otherwise, the organs should be discarded.