bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis
Authors: Feuerstadt Paul , Boules Mena , Stong Laura , Dahdal David N , Sacks Naomi C , Lang Kathleen , Nelson Winnie W
Published: January 2021

Objective:

Clostridioides difficile infection and recurrent C. difficile infection result in substantial economic burden and healthcare resource use. Sepsis and bowel surgery are known to be serious complications of C. difficile infection. This study evaluated clinical complications in patients with C. difficile infection and recurrent C. difficile infection during a 12-month period following the primary C. difficile infection.

Methods:

A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus™ database was conducted for patients aged 18–64 years with an index C. difficile infection episode requiring inpatient stay or an outpatient visit for C. difficile infection followed by a C. difficile infection treatment. Each C. difficile infection episode ended after a 14-day C. difficile infection-claim-free period was observed. Recurrent C. difficile infection was defined as a further C. difficile infection episode within an 8-week window following the claim-free period. Clinical complications were documented over 12 months of follow-up and stratified by the number of recurrent C. difficile infection episodes (0 rCDI, 1 rCDI, 2 rCDI, and 3+ rCDI).

Results:

In total, 46,571 patients with index C. difficile infection episode were included. During the 6-month pre-index, the mean (standard deviation) baseline Charlson comorbidity index score, by increasing the recurrent C. difficile infection group, was 1.2 (1.9), 1.5 (2.2), 1.8 (2.3), and 2.3 (2.5). During the 12-month follow-up, sepsis occurred in 16.5%, 27.3%, 33.1%, and 43.3% of patients, and subtotal colectomy or diverting loop ileostomy was performed in 4.6%, 7.3%, 8.9%, and 10.5% of patients, respectively, by increasing the recurrent C. difficile infection group.

Conclusions:

Reduction in recurrent C. difficile infection is an important step to reduce the burden of serious clinical complications, and new treatments are needed to reduce C. difficile infection recurrence.
Decision-making factors in prenatal testing: A systematic review
Authors: Di Mattei Valentina , Ferrari Federica , Perego Gaia , Tobia Valentina , Mauro Fabio , Candiani Massimo
Published: January 2021

This review examines the factors that affect the decision-making process of parental couples evaluating prenatal screening and diagnostic tests. A systematic search was performed using PubMed and PsycInfo databases. The 46 included studies had to: investigate the decision-making process about prenatal testing; focus on tests detecting trisomy 21, 18, 13, and abnormalities of sex chromosomes; be published in English peer-reviewed journals. The decision-making process seems composed of different levels: an individual level with demographic, clinical, and psychological aspects; a contextual level related to the technical features of the test and the information received; a relational level involving family and society.
Novel MIS 3D NAV Single Step Pedicle Screw System (SSPSS): Workflow, Accuracy and Initial Clinical Experience
Authors: Schmidt Franziska A. , Lekuya Hervé M. , Kirnaz Sertac , Hernandez Robert Nick , Hussain Ibrahim , Chang Louis , Navarro-Ramirez Rodrigo , Wipplinger Christoph , Rawanduzy Cameron , Härtl Roger
Published: January 2021

Study Design:

Prospective case series.

Objective:

SSPSS (single step pedicle screw system) was developed for minimally invasive spine surgery. We performed this study to report on safety, workflow, and our initial clinical experience with this novel technique.

Methods:

The prospective study was conducted on patients who underwent pedicle screw fixation between October 2017 and April 2018 using a novel single step 3D navigated pedicle screw system for MIS. Outcome measurements were obtained from intraoperative computerized tomography. The images were evaluated to determine pedicle wall penetration. We used a grading system to assess the severity of the pedicle wall penetration. Breaches were classified as grade 1 (<2 mm), grade 2 (2-4 mm), or grade 3 (<4 mm), 1 and as cranial, caudal, medial, and lateral.

Results:

Our study includes 135 screws in 24 patients. SSPSS eliminated K-wires and multiple steps traditionally necessary for MIS pedicle screw insertion. The median time per screw was 2.45 minutes. 3 screws were corrected intraoperatively. Pedicle wall penetration occurred in 14 screws (10%). Grade 1 breaches occurred in 4 screws (3%) and grade 2 breaches occurred in 10 screws (7%). Lateral breaches were observed more often than medial breaches. The accuracy rate in our study was 90% (Grade 0 breach). No revision surgeries were needed and no complications occurred.

Conclusions:

Our study suggests that SSPSS could be a safe, accurate, and efficient tool. Our accuracy rate is comparable to that found in the literature.
What Are Risk Factors for an Ileus After Posterior Spine Surgery?—A Case Control Study
Authors: Yilmaz Emre , Benca Eric , Patel Akil P. , Hopkins Sarah , Blecher Ronen , Abdul-Jabbar Amir , O’Lynnger Thomas M. , Oskouian Rod J. , Norvell Daniel C. , Chapman Jens
Published: January 2021

Study design:

Case-Control Study.

Objective:

The purpose of this retrospective study is to evaluate risk factors for developing a postoperative ileus after posterior spine surgery.

Methods:

Patient charts, including radiographs were evaluated retrospectively. Diagnosis of an ileus was confirmed radiographically by a CT scan in all cases. The control group was retrieved by selecting a random sample of patients undergoing posterior spine surgery who did not develop bowel dysfunction postoperatively.

Results:

A total of 40 patients had a postoperative ileus. The control group consisted of 80 patients. Both groups did not differ significantly in age, gender, BMI, tobacco use, comorbidities or status of previous abdominal surgery. Significant differences between the 2 groups was the length of stay (5.9 vs. 11.2; p = 0.001), surgery in the lumbar spine (47.5% vs. 87.5%; p < 0.001) and major spine surgery involving > 3 levels (35.0% vs. 57.5%; p = 0.019). Patients who suffered from an ileus were more likely to be treated in ICU (23.8% vs. 37.5%; p = 0.115), being re-admitted (0.0% vs 5.0%; p = 0.044) and having a delayed discharge (32.5% vs. 57.5%; p = 0.009). Multivariable analysis demonstrated that lumbar spine surgery compared to thoracic and/or cervical spine surgery (p = 0.00, OR 8.7 CI 2.9-25.4) and major spine surgery involving > 3 levels (p = 0.012; OR 3.0, CI 1.3-7.2) are associated with developing an ileus postoperatively.

Conclusion:

Surgeries of the lumbar spine as well as those involving > 3 levels are associated with developing a postoperative ileus. Further studies are needed to expand on possible risk factors and to better understand the mechanism underlying postoperative ileus in spine surgery patients.
Biodegradable magnesium screws in elbow fracture fixation: Clinical case series
Authors: Lam Wai-Him , Tso Chi-Yin , Tang Ning , Cheung Wing-Hoi , Qin Ling , Wong Ronald Man-Yeung
Published: January 2021

Biodegradable magnesium-based implants are innovative alternatives that potentially eliminate the need for implant removal. Recent studies have demonstrated the osteogenic properties and bacterial inhibition potentials of magnesium screws. We reported a clinical series of three elbow fracture cases, where magnesium screws were used in the treatment of one radial head and two capitellum fractures. Postoperative clinical courses were uneventful, and fracture healing occurred within 3 months. In all cases, radiolucencies were observed around implants especially in the screw head region at 2 months post-operation, but disappeared with consolidation at 1 year post-operation. All patients achieved near normal range of motion, minimal symptoms and good functional outcomes. No complication such as failure of fixation, loss of reduction, malunion or infection was seen. No implant revision or removal was necessary. Magnesium bioabsorbable screws are shown to be a viable option for these fractures.
Evaluation of the Connective Tissue Wall in Sporadic Cases of Keratocystic Odontogenic Tumor (KCOT) Using MMP-9 and Confocal Microscopy: A Retrospective Study
Authors: Jayaraj Merlin , Ramani Pratibha , Sherlin Herald J.
Published: January 2021

Background:

Keratocystic odontogenic tumor (KCOT) is an odontogenic lesion which manifests distinct biological behavior. Predominant studies in KCOT attribute this behavior to high epithelial proliferative capacity. Besides, a few studies facet loosely arranged collagen can contribute to the behavior of KCOT. Matrix metalloproteinases (MMP) are enzymes that degrade extracellular matrix components under both physiologic and pathologic conditions. The loosely arranged collagen in connective tissue wall of KCOT could be related to the degree of MMP-9 expression.

Aim:

To evaluate the arrangement of collagen fibers along with immunoexpression of MMP-9 and to relate to its neoplastic biologic behavior in sporadic cases of KCOT.

Materials and Methods:

KCOT ( n = 23) and dentigerous cyst (DC) ( n = 15) samples were processed for the following techniques: Masson’s trichrome stain for light microscopy, PMA-PSR stain for confocal microscopy, and MMP-9 for immunohistochemistry.

Results:

In Masson’s trichrome analysis, correlation of collagen fiber arrangement in the deeper regions with color intensity for KCOT was found to be statistically significant ( P = .033). In confocal microscopy, there was no difference between intensities in KCOT ( P = .990) and DC ( P = .233), respectively. The immunoexpression of MMP-9 in the connective tissue wall of DC (73.3%) was relatively higher than that of KCOT (60.8%). However, on comparison between KCOT and DC in the presence of inflammation, the immunoexpression of MMP-9 was higher in DC (100%) than KCOT (69.9%) and was statistically significant ( P = .028).

Conclusion:

It was concluded that the loose connective tissue wall in KCOT is because of the inherent nature of the lesion that could facilitate its biologic behavior. If inflammation is present, this could further aggravate the tumorigenic behavior.
Tuberculosis in Pediatric Solid Organ and Hematopoietic Stem Cell Recipients
Authors: Dubois Melanie , Dixit Avika , Lamb Gabriella
Published: January 2021

Children undergoing solid organ and hematopoietic stem cell transplantation are at high risk of morbidity and mortality from tuberculosis (TB) disease in the post-transplant period. Treatment of TB infection and disease in the post-transplant setting is complicated by immunosuppression and drug interactions. There are limited data that address the unique challenges for the management of TB in the pediatric transplant population. This review presents the current understanding of the epidemiology, clinical presentation, diagnosis, management, and prevention for pediatric transplant recipients with TB infection and disease. Further studies are needed to improve diagnosis of TB and optimize treatment outcomes for these patients.
Patient Involvement in Medical Education Research: Results From an International Survey of Medical Education Researchers
Authors: Moreau Katherine A , Eady Kaylee , Heath Sarah E
Published: January 2021

There are demands to involve patients in medical education research (MER). This study surveyed researchers to examine the extent and nature of patient involvement in MER. It obtained 283 completed surveys (response rate of 5%). Of the respondents, 153 (54.1%) indicated that they involve patients in MER. Of these respondents, 102 (66.7%) stated that patients are data sources in MER, 41 (26.8%) noted that patients are involved as advisors and/or reviewers, and/or 22 (14.4%) indicated that patients are involved as team members. These respondents reported that they involve patients to improve the relevance of their MER to patients (n = 99; 64.7%), connect MER to patient outcomes (n = 98; 64.1%), and improve the appropriateness of MER (n = 92; 60.1%). The 130 respondents who do not involve patients in MER do not involve them because they believe that their research topic(s) are irrelevant to patients (n = 68; 52.3%), they have limited resources for patient involvement (n = 40; 30.8%), and/or they do not know how to involve patients (n = 28; 21.5%). Researchers need to consider how they can conduct their MER with patients.
Feasibility and Limitations of Proning Protocol for Nonintubated Patients With COVID-19
Authors: Shoults Benjamin , Barber Mary , Millham Lucia , Mulla Maaz , Nanji Natasha , Steele Grant , Peck Tyler , Smithedajkul Patrick , Worsham Christopher , Currier Paul , Raphaely Rebecca A
Published: January 2021

Proning awake patients with COVID-19 is associated with lower mortality and intubation rates. However, these studies also demonstrate low participation rates and tolerance of awake proning. In this study, we attempt to understand barriers to proning. Medical and dental students surveyed nonintubated patients to understand factors affecting adherence to a proning protocol. Only patients who discussed proning with their medical team attempted the practice. Eight of nine patients who were informed about benefits of proning attempted the maneuver. Discomfort was the primary reason patients stopped proning. Addressing discomfort and implementing systematic patient education may increase adherence to proning.
Decreased Wait Time and Increased Satisfaction With Bedside Pancreatic Enzyme Dosing for the Inpatient Adolescent With Cystic Fibrosis: A Quality Improvement Project Comparing Enzyme Self-Administration to Nurse Administration
Authors: Middour-Oxler Brandi , Gettis Margaret , Dye Betsy
Published: January 2021

For children with cystic fibrosis (CF), enzymes are essential with meals to absorb nutrients and ensure adequate growth. When hospitalized, CF patients typically rely on nurse-administered medications. Recently, a pediatric hospital unit began allowing adolescents with CF enzymes at the bedside. Postimplementation, a satisfaction questionnaire was administered to participating patients and nurses measuring patient and nurse satisfaction with access to bedside enzymes versus nurse administration and overall time for enzyme delivery. The survey utilized a 5-point Likert scale. The wait time for pancreatic enzymes decreased for self-administered enzymes when compared to those that were nurse administered. All (11/11) patients and 86% (12/14) of nurses preferred the self-administration of enzymes. Hospitalized pediatric CF patients and nurses had higher levels of satisfaction with enzyme self-administration. Immediate access to enzymes in room safes impact patient autonomy, reflecting home self-care practices. Decreases in wait times optimize nutritional growth and healing while hospitalized. As a result, a new limited scope policy allowing patient-administered enzymes is now in place in the pediatric inpatient CF unit.
Experiences of Women Who Gave Birth in US Hospitals During the COVID-19 Pandemic
Authors: Mollard Elizabeth , Wittmaack Amaya
Published: January 2021

The purpose of this study was to describe the experiences of women who gave birth in a US hospital during the COVID-19 pandemic. Women who gave birth between March and July 2020 completed a survey on the experience of giving birth during a pandemic. Of this, 885 women were consented and participated in the study; 22.5% of women reported hypertension, 33.8% reported anxiety, 18.6% reported depression, and 1.13% reported testing positive for COVID-19. Of this, 61% of women reported inadequate support for childbirth, and 20.5% reported that they did not feel safe giving birth in the hospital. Women who tested positive for COVID-19 were more likely to be of Asian race, have a cesarean delivery, not have a birth partner present, and discontinue breastfeeding before 6 weeks. Pandemic-related changes to maternity care practices may have impacted birthing women’s perceptions of safety and support in the hospital environment and affected symptoms of stress. Health care policy and maternity care practices should promote feelings of safety and control and overall experience for women giving birth in the hospital during a pandemic.
Who Stays Physically Active during COVID-19? Inequality and Exercise Patterns in the United States
Authors: Sher Chloe , Wu Cary
Published: January 2021

Exercising is crucial to keeping up physical and mental health during the coronavirus disease 2019 (COVID-19) pandemic. In this visualization, the authors consider how existing social inequalities may create unequal physical exercise patterns during COVID-19 in the United States. Analyzing data from a nationally representative Internet panel of the University of Southern California Center for Economic and Social Research Understanding Coronavirus in America project (March to December), the authors find that although all Americans have become physically more active since the outbreak, the pandemic has also exacerbated the inequality in physical exercise. Specifically, the authors show that the gaps in physical exercise have widened substantially between men and women, whites and nonwhites, the rich and the poor, and the educated and the less educated. Policy interventions addressing the widening inequality in physical activity can help minimize the disproportionate mental health impact of the pandemic on disadvantaged populations.
COVID-19: Mourning, Knowledge and Improvisation
Authors: Singh Ravi Nandan
Published: January 2021

As we live and die through the continuing pandemic, one particular affect that relates us globally is of the dead awaiting their funerary repose. Assessing the pandemic, Arif (2020) in an early reflection proposes that we might benefit in our assessment of the ‘bio-social’ of the pandemic by admitting to the sovereignty of the virus. Borrowing this premise, I suggest further that the sovereignty of the virus is acutely manifested in the commingled presence of the living and unreposed dead in the temporary, improvised morgues. Although the continuing pandemic is quite unprecedented, it can be partially recognised in knowledges gained in mourning that register how disasters force a ‘descent’ (Das 2006) and ‘fall’ (Rosaldo 2014) into accepting improvisation of life and death forms. This descent and fall can be towards an abyss risking the very continuum of life, but what we also gain from discerning the relation of mourning with knowledge is that life can be regained at many levels of the fall. Just as the unreposed dead manifest the sovereignty of the virus, I suggest this descent and fall can be ethically attested in improvisation as the social surface of regaining life. It is my contention that this full-time improvisation, which in turn must be its own source, energy and end, must operate facing the unreposed dead. Deriving and extending from my own work of studying the dead, the present essay shows this improvisation and regaining of life through two brief assemblages of bacteriophage virus and media morgue. The relation of mourning and knowledge is built through the essay to arrive at the conclusion that the classic trope of life cycle in anthropology has to be seen as part of a complex texture of the social where vitality and the unreposed dead are concurrent and overlapping.
Children living in institutional care in northern India: A study
Authors: Rohta Sonam
Published: January 2021

A very large number of children live without parental care in the entire world. Poverty is considered to be the main reason behind institutionalization of the children because 80% of children living in care have at least one parent alive. The present paper emphasizes on the trends of institutional care in India where the large population is poor. Keeping in view the socio-economic conditions of the country, it is an attempt to explore the challenges and living conditions of children in institutional care run by government and non-governmental organizations in the regions of Punjab and Chandigarh in northern India. The findings of the study are based on the empirical data that included around 177 institutionalized children both boys and girls between the age group of 5 and 18 years living in four different children’s institutions. The study also provides suitable recommendations for better alternative care in countries with large populations of vulnerable children.
Emerging Narratives in the Wake of Homicide: Victim, Survivor and Transcender
Authors: Discola Kristen Lee
Published: January 2021

This work draws upon participant observation of 96 victim-centred events, 36 intensive interviews with individuals who had lost loved ones to homicide (co-victims), and content analysis of a variety of written narratives. Using a symbolic interactionist framework, it presents three narrative types that were found to emerge in the wake of violent loss. Termed ‘victim’, ‘survivor’, and ‘transcender’ narratives, this paper demonstrates how each narrative type is distinct in terms of focus, tone and purpose. In doing so, it offers insight into the aftermath of crime as it relates to the victim experience.
Proximal, Local, and Distal Muscle Morphology in Women With Patellofemoral Pain
Authors: Pompeo Klauber Dalcero , da Rocha Emmanuel Souza , Melo Mirella Ayres , de Oliveira Nathalia Trevisol , Oliveira Daniel Fernandes , Sonda Francesca Chaida , dos Santos Patrícia Freitas , Rodrigues Rodrigo , Vaz Marco Aurélio
Published: January 2021

Objective:

The objective of this study was to compare proximal, local, and distal muscle morphology in women with and without patellofemoral pain (PFP).

Materials and Methods:

Proximal, local, and distal muscle thicknesses (MTs) were obtained with B-mode sonography in healthy (control group [CG], n = 20) and PFP (PFP group, n = 20) women. In addition, muscle mass was measured by the sum of the synergistic MTs. Data were analyzed by independent t-test, Mann-Whitney U test, and effect size.

Results:

PFP women had smaller gluteus medius ( P = .02, d = 0.7), vastus medialis ( P < .01, d = 1.0), and flexor digitorum brevis ( P < .01, d = 1.0) MT and greater gastrocnemius medialis ( P = .04, d = 0.6) MT than CG. Quadriceps muscle mass ( P = .01, d = 0.8) and foot muscle mass ( P = .008, d = 0.9) were smaller, while plantar flexor muscle mass was greater in the PFP group than in CG ( P = .01, d = 0.8).

Conclusion:

PFP women have proximal, local, and distal MT alterations in comparison with CG, which may explain possible changes in muscle strength and functionality.
Gray-Scale Sonography of the Spinal Cord in Postlaminectomy Patient
Authors: Juneja Pallavi , Frenkel Mark B. , Carmichael Sam P. , Sarwal Aarti
Published: January 2021

Laminectomy, a common neurosurgical procedure that decompresses the spinal cord, is the definitive surgical treatment for spinal epidural abscesses. Although complications after laminectomy occur infrequently, they can cause significant morbidity and health care resource usage. These complications include soft tissue collections like a persistent and/or new abscess or a hematoma. The preferred method of diagnosis for spinal soft tissue collections is magnetic resonance imaging. However, traditional neuroimaging poses significant challenges in patients with spinal hardware due to metallic artifact precluding appropriate visualization of anatomy and pathology. This was a case of a patient with extensive spinal hardware where visualization of the spinal cord by postoperative sonography was made feasible by a lack of bone after a laminectomy. Point-of-care ultrasound, a convenient bedside tool with the ability to detect soft tissue collections easily, was used to monitor for postoperative recurrence of a spinal epidural abscess in this patient. Patients with an intact spine do not have adequate acoustic windows due to posterior vertebral anatomy. In postlaminectomy patients without posterior vertebral structures, sonography may offer a diagnostic modality for postoperative monitoring. Ultrasonographers can employ spinal cord sonography, particularly when the indication for decompressive laminectomy was a localized fluid collection or abscess.
Active surveillance of primary extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue
Authors: Joffe Erel , Leyfman Yan , Drill Esther , Rajeeve Sridevi , Zelenetz Andrew D. , Palomba M. Lia , Moskowitz Craig H. , Portlock Carol , Noy Ariela , Horwitz Steven M. , Gerecitano John F. , Moskowitz Alison , Hamlin Paul , Matasar Matthew J. , Kumar Anita , Batlevi Connie L. , Younes Anas , Straus David J.
Published: January 2021

Although patients with bronchus-associated lymphoid tissue (BALT) lymphoma show an indolent clinical course, appropriate disease management at diagnosis is not well defined. This study aimed to compare 3 treatment strategies for patients with BALT lymphoma: active surveillance, systemic chemotherapy or immunotherapy at diagnosis, or complete surgical resection at diagnosis. We conducted a retrospective study of all patients with new diagnoses of marginal zone lymphoma (MZL) involving the lung who were treated at the Memorial Sloan Kettering Cancer Center between 1995 and 2017. Primary BALT lymphoma was defined as disease confined to the lungs and adjacent lymph nodes. Active surveillance was defined as a documented observation plan and ≥3 months of follow-up before initiating treatment. Overall survival (OS) and event-free survival (EFS) were compared between treatment groups. We reviewed 200 consecutive patients with MZL involving the lung; 123 met the inclusion criteria and were managed by active surveillance (47%), complete surgical resection (41%), or systemic chemotherapy or immunotherapy (11%). With a median follow-up of >60 months, surgical resection was associated with a superior EFS compared with active surveillance and systemic treatment (6-year EFS: 74% vs 65% vs 62%, respectively; P = .013). Larger lesions and thrombocytopenia were associated with shorter EFS. All groups had excellent OS at 6 years (93%), albeit with a slight superiority for surgical resection (100%) over active surveillance (91%) and systemic treatment (76%) (P = .024). BALT lymphoma is an indolent disease that can often be managed expectantly and not require therapy for many years.
Genome-wide identification and comprehensive analysis of NAC family genes involved in fruit development in kiwifruit (Actinidia)
Authors: Jia Dongfeng , Jiang Zhiqiang , Fu Haihui , Chen Lu , Liao Guanglian , He Yanqun , Huang Chunhui , Xu Xiaobiao
Published: January 2021

Background

NAC transcription factors (TFs) are plant-specific proteins encoded by a large gene family. They play important roles in diverse biological processes, such as plant growth and development, leaf senescence, and responses to biotic or abiotic stresses. Functions of a number of NAC TFs have been identified mainly in model plants. However, very few studies on NAC TFs have been conducted in the fruit tree of kiwifruit.

Results

Genome-wideNACgenes were identified and their phylogeny, genomic structure, chromosomal location, synteny relationships, protein properties and conserved motifs were analyzed. In addition, the fruit developmental process was evaluated in a new kiwifruit cultivar ofActinidia eriantha‘Ganlu 1’. And expressions for all thoseNACgenes were analyzed by quantitative real-time PCR method in fruits of ‘Ganlu 1’ during its developmental process. Our research identified 142 NAC TFs which could be phylogenetically divided into 23 protein subfamilies. The genomic structures of thoseNACgenes indicated that their exons were between one and ten. Analysis of chromosomal locations suggested that 116 out of 142NACs distributed on all the 29 kiwifruit chromosomes. In addition, genome-wide gene expression analysis showed that expressions of 125 out of 142NACgenes could be detected in fruit samples.

Conclusion

Our comprehensive study provides novel information onNACgenes and expression patterns in kiwifruit fruit. This research would be helpful for future functional identification ofNACgenes involved in kiwifruit fruit development.
Evaluate construct validity of the Revised American Pain Society Patient Outcome Questionnaire in gynecological postoperative patients using confirmatory factor analysis
Authors: Chaw Sook Hui , Lo Yoke Lin , Lee Jia Yin , Wong Jia Wing , Zakaria Wan Aizat Wan , Ruslan Shairil Rahayu , Tan Wei Keang , Shariffuddin Ina Ismiarti
Published: January 2021

Background

The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) evaluates the patient-reported quality of pain management in adults. A validated APS-POQ-R is pivotal to guide effective pain management with better patient satisfaction. Previous studies revealed that subscales of “patients’ perception of pain management” were unstable cross-culturally. This study aims to evaluate the construct validity of the APS-POQ-R in gynecological postoperative patients with a multi-cultural background using confirmatory factor analysis to allow comparisons among different a priori models at the latent factor level.

Methods

Patients aged 18 years old or above and who were scheduled for gynecology surgery were selected. Three different models with a combination of latent factors were based on a priori hypotheses from previous studies. The root-mean-squared error of approximation, comparative fit index, Tucker-Lewis Index, Chi-squared test, and change in Chi-squared statistic given a change in degrees of freedom between models were used to assess the model fit to the present data.

Results

A total of 302 patients completed the questionnaire. The five-factor model which was based on Gordon’s study has an acceptable fit for the data and was superior when compared to the one-factor baseline model. Although the four-factor model, which originated from Botti’s study, also demonstrates a good model fit, the “perception of care” construct was excluded in this model. The “perception of care” construct is conceptually important as patient-centered care has become the focus of quality improvement of pain service.

Conclusions

The APS-POQ-R is easy to administer and is useful for quality evaluation in postoperative pain management. The present study demonstrates that a five-factor structure of the APS-POQ-R is the best fitting model in our patient sample. The results of this study provide further evidence to support the use of APS-POQ-R as a measurement tool for pain management evaluation in acute postoperative patients with a multi-cultural background.
Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
Authors: Tian Xinyi , Niu Kaifan , Cao Hong , Zhan Gonghao , Zhang Yan , Xu Feng , Shangguan Wangning , Gao Ye
Published: January 2021

Background

Pruritus is one of the most common side effects of epidural morphine administered for post-surgery analgesia, and pregnant women tend to be highly susceptible. The relative contributions of morphine concentration, local anesthetics, and level of pain to pruritus after epidural morphine for post-cesarean delivery analgesia remain unclear. Accordingly, the present study aimed to identify risk factors for pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia.

Methods

This case control study was based on routinely collected clinical data. Participants included women who had undergone cesarean section and adopted a patient-controlled analgesia pump for postoperative analgesia. A series of logistic regression analyses were performed. Interaction terms were added to explore the moderation effects of combined local anesthetics and pain level on associations between morphine concentration and pruritus. Robustness of the results was checked through sensitivity analysis using propensity scores matching approach.

Results

Higher morphine concentration, assisted reproductive treatment, and multipara and cesarean section history were significantly more prevalent in the pruritus group than in the control group. The probabilities of pruritus at morphine concentrations of 10, 15, 20, 25, 30 and 40 μg/mL increased sequentially from 0.05, 0.1, 0.2, 0.35, 0.54 to 0.84, respectively. The trend remained steep in the ropivacaine stratum and became flatter when combined with levobupivacaine. At mild pain combined with levobupivacaine, the incidence of pruritus increased from 0.33 (95% confidence interval [CI] 0.1–0.68) in the 10 μg/mL morphine group to 0.48 (95% CI 0.1–0.88) in the 40 μg/mL morphine group. In the stratum of moderate pain combined with levobupivacaine, the incidence increased from 0.4 (95% CI 0.04–0.92) to 0.56 (95% CI 0.03–0.98). The results in the sensitivity analysis were in consistent with above findings.

Conclusions

Higher concentrations of morphine, multipara, and assisted reproductive treatment were factors associated with a higher probability of pruritus. Pain level or combined local anesthetics could moderate the association between morphine concentration and pruritus.
Severe pneumonia in adults caused by Tropheryma whipplei and Candida sp. infection: a 2019 case series
Authors: Li Wei , Zhang Qun , Xu Yanling , Zhang Xiyue , Huang Qian , Su Zhenzhong
Published: January 2021

Background

Whipple’s disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which not only affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can also be simultaneously involved. The aim of this report was to be able to alert the clinician to severe pneumonia caused by TW combined with Candida sp.

Case presentation

The case study was conducted on patients in September and November 2019. After routine examination and treatment, the results were not satisfactory. A bronchoalveolar lavage (BAL) using metagenomics next-generation sequencing was conducted on two adults who presented with fever, cough, and progressive dyspnea and who had no history of gastrointestinal symptoms, immunodeficiency diseases, or use of immunosuppressive agents. TW and Candida sp. were detected in in BAL.

Conclusions

This is a report of life-threatening pneumonia caused by TW combined with Candida sp. in a Chinese population.
Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study
Authors: Itami Yoshitaka , Miyake Makito , Owari Takuya , Iwamoto Takashi , Gotoh Daisuke , Momose Hitoshi , Fujimoto Kiyohide , Hirao Shuya
Published: January 2021

Background

A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment.

Methods

Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined.

Results

Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 min were independent risk factors of fUTI following the URSL.

Conclusions

F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 min or less in patients with obstructive pyelonephritis.
More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy
Authors: Carpagnano Giovanna E. , Migliore Giovanni , Grasso Salvatore , Procacci Vito , Resta Emanuela , Panza Francesco , Resta Onofrio
Published: January 2021

Background

Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management.

Methods

In the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020).

Results

With improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 daysvs. who survived 6.4 ± 3.3 days). T

Conclusions

The present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.
Mask side-effects in long-term CPAP-patients impact adherence and sleepiness: the InterfaceVent real-life study
Authors: Rotty Marie-Caroline , Suehs Carey M. , Mallet Jean-Pierre , Martinez Christian , Borel Jean-Christian , Rabec Claudio , Bertelli Fanny , Bourdin Arnaud , Molinari Nicolas , Jaffuel Dany
Published: January 2021

Background

For some patients, Continuous Positive Airway Pressure (CPAP) remains an uncomfortable therapy despite the constant development of technological innovations. To date, no real life study has investigated the relationship between mask related side-effects (MRSEs) and CPAP-non-adherence (defined as < 4 h/day) or residual-excessive-sleepiness (RES, Epworth-Sleepiness-Scale (ESS) score ≥ 11) in the long-term.

Methods

The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks). MRSEs were evaluated using visual-analogue-scales, CPAP-data using CPAP-software, sleepiness using ESS.

Results

1484 patients were included in the analysis (72.2% male, median age 67 years (IQ25–75: 60–74), initial Apnea–Hypopnea-Index (AHI) of 39 (31–56)/h, residual AHIflow was 1.9 (0.9–4) events/h), CPAP-treatment lasted 4.4 (2.0–9.7) years, CPAP-usage was 6.8 (5.5–7.8) h/day, the prevalence of CPAP-non-adherence was 8.6%, and the prevalence of RES was 16.17%. Leak-related side-effects were the most prevalent side-effects (patient-reported leaks concerned 75.4% of responders and had no correlation with CPAP-reported-leaks). Multivariable logistic regression analyses evaluating explanatory-variable (demographic data, device/mask data and MRSEs) effects on variables-of-interest (CPAP-non-adherence and RES), indicated for patient-MRSEs significant associations between: (i) CPAP-non-adherence and dry-mouth (p = 0.004); (ii) RES and patient-reported leaks (p = 0.007), noisy mask (p < 0.001), dry nose (p < 0.001) and harness pain (p = 0.043).

Conclusion

In long-term CPAP-treated patients, leak-related side-effects remain the most prevalent side-effects, but patient-reported leaks cannot be predicted by CPAP-reported-leaks. Patient-MRSEs can be independently associated with CPAP-non-adherence and RES, thus implying a complementary role for MRSE questionnaires alongside CPAP-device-reported-data for patient monitoring.

Trial registration InterfaceVent is registered with ClinicalTrials.gov (NCT03013283).
Optimization of the Mainzelliste software for fast privacy-preserving record linkage
Authors: Rohde Florens , Franke Martin , Sehili Ziad , Lablans Martin , Rahm Erhard
Published: January 2021

Background

Data analysis for biomedical research often requires a record linkage step to identify records from multiple data sources referring to the same person. Due to the lack of unique personal identifiers across these sources, record linkage relies on the similarity of personal data such as first and last names or birth dates. However, the exchange of such identifying data with a third party, as is the case in record linkage, is generally subject to strict privacy requirements. This problem is addressed by privacy-preserving record linkage (PPRL) and pseudonymization services. Mainzelliste is an open-source record linkage and pseudonymization service used to carry out PPRL processes in real-world use cases.

Methods

We evaluate the linkage quality and performance of the linkage process using several real and near-real datasets with different properties w.r.t. size and error-rate of matching records. We conduct a comparison between (plaintext) record linkage and PPRL based on encoded records (Bloom filters). Furthermore, since the Mainzelliste software offers no blocking mechanism, we extend it by phonetic blocking as well as novel blocking schemes based on locality-sensitive hashing (LSH) to improve runtime for both standard and privacy-preserving record linkage.

Results

The Mainzelliste achieves high linkage quality for PPRL using field-level Bloom filters due to the use of an error-tolerant matching algorithm that can handle variances in names, in particular missing or transposed name compounds. However, due to the absence of blocking, the runtimes are unacceptable for real use cases with larger datasets. The newly implemented blocking approaches improve runtimes by orders of magnitude while retaining high linkage quality.

Conclusion

We conduct the first comprehensive evaluation of the record linkage facilities of the Mainzelliste software and extend it with blocking methods to improve its runtime. We observed a very high linkage quality for both plaintext as well as encoded data even in the presence of errors. The provided blocking methods provide order of magnitude improvements regarding runtime performance thus facilitating the use in research projects with large datasets and many participants.
Brain activity during real-time walking and with walking interventions after stroke: a systematic review
Authors: Lim Shannon B. , Louie Dennis R. , Peters Sue , Liu-Ambrose Teresa , Boyd Lara A. , Eng Janice J.
Published: January 2021

Investigations of real-time brain activations during walking have become increasingly important to aid in recovery of walking after a stroke. Individual brain activation patterns can be a valuable biomarker of neuroplasticity during the rehabilitation process and can result in improved personalized medicine for rehabilitation. The purpose of this systematic review is to explore the brain activation characteristics during walking post-stroke by determining: (1) if different components of gait (i.e., initiation/acceleration, steady-state, complex) result in different brain activations, (2) whether brain activations differ from healthy individuals. Six databases were searched resulting in 22 studies. Initiation/acceleration showed bilateral activation in frontal areas; steady-state and complex walking showed broad activations with the majority exploring and finding increases in frontal regions and some studies also showing increases in parietal activation. Asymmetrical activations were often related to performance asymmetry and were more common in studies with slower gait speed. Hyperactivations and asymmetrical activations commonly decreased with walking interventions and as walking performance improved. Hyperactivations often persisted in individuals who had experienced severe strokes. Only a third of the studies included comparisons to a healthy group: individuals post-stroke employed greater brain activation compared to young adults, while comparisons to older adults were less clear and limited. Current literature suggests some indicators of walking recovery however future studies investigating more brain regions and comparisons with healthy age-matched adults are needed to further understand the effect of stroke on walking-related brain activation.
Prevalence and characteristics of hepatitis B and D virus infections among HIV-positive individuals in Southwestern Nigeria
Authors: Opaleye Oluyinka Oladele , Akanbi Olusola Anuoluwapo , Osundare Folakemi Abiodun , Wang Bo , Adesina Olufisayo , Oluremi Adeolu Sunday , Sunday Sola Thomas , Akindele Abiodun Akeem , Klink Patrycja , Bock C. Thomas
Published: January 2021

Background

Coinfections of HIV-positive individuals with Hepatitis B and D virus (HBV and HDV) are common and can be associated with rapid liver damage. Several antiretroviral drugs for HIV exhibit anti-HBV effect; however, the selection of HBV drug resistance mutations (DRMs) in individuals under HIV antiretroviral therapy (ART) has been reported but rarely in Nigeria. In this study the HBV/HDV prevalence and HBV DRMs in HIV-positive individuals in Southwestern Nigeria were assessed.

Methods

Plasma samples collected from 310 HIV-positive individuals including 295 ART-experienced and 15 ART-naïve persons attending the HIV clinic in three south-western states of Nigeria between June 2017 and August 2017 were analysed by ELISA for HBsAg and anti-HDV. The presence of HDV RNA and HBV DNA was analysed by (RT)-PCR followed by sequencing and phylogenetic analyses for genotyping. The HBV reverse transcription (RT) region was amplified and sequenced for the analysis of drug resistance mutations.

Results

Overall, 16.1% (n = 50/310) of the HIV-positive individuals were positive for HBsAg, most of which were ART-experienced (94.0%; n = 47/50). From the 50 HBsAg-positive samples, 72.0% (n = 36/50) were positive for HBV DNA and 16.0% (n = 8/50) had detectable HDV RNA while 5.6% (n = 2/36) of the HBV-DNA positive samples had anti-HDV total antibodies. Sequences were available for 31/36 of the HBV DNA-positive and 3/8 HDV RNA-positive samples. HBV DNA-positive samples were characterised as HBV genotype E infections exclusively, while HDV genotype 1 was detected in the HDV RNA-positive samples. HBV DRMs V173L, L180M, S202I and M204V/I, which are associated with lamivudine resistance, were detected in 32.2% (n = 10/31) of the HBV DNA-positive samples. Most of these mutations (90.0%; n = 9/10) were present in the ART-experienced cohort.

Conclusions

This study indicates that HBV/HDV coinfections are common in HIV-positive individuals under ART in Nigeria. Furthermore, a high proportion of HBV DRMs which potentially compromise future treatment options were detected, underscoring the need for HBV screening prior to starting ART. Further studies should be performed to monitor a possible increase in the spread of HDV among populations at risk of HIV and HBV infections.