bluuebunny/crossref_metadata_2025 huggingface dataset:
Anomalous origin of the left pulmonary artery from the ascending thoracic aorta and a right patent ductus arteriosus associated with pulmonary hypertension in a woman of childbearing age: an unprecedented approach
Authors: Santos João Grade , Ferreira Filipa , Alegria Sofia , Pereira Helder
Published: May 2022

A female patient in her early 30s, with a medical history of pulmonary arterial hypertension associated with congenital heart disease, lost to follow-up, was referred to a pulmonary hypertension reference centre. The patient presented at a WHO functional class of II in a low-risk category. A transthoracic echocardiogram demonstrated severe pulmonary hypertension with right ventricular dysfunction. A cardiac MRI demonstrated a right aortic arch with anomalous origin of the left pulmonary artery from the ascending thoracic aorta and a patent ductus arteriosus. A right heart catheterisation confirmed the presence of severe pulmonary hypertension. The patient was started on combined vasodilator therapy with an improvement in symptoms and remaining in a low-risk category. This represents one of the oldest described cases of such an anomaly and the first description of response to vasodilator therapy, highlighting the importance of a structured approach in a reference centre for achieving optimal outcomes.
Recovery of neurological function following type B aortic dissection complicated by paraplegia
Authors: Li Ben , Khoshhal Zeyad , Common Andrew , Qadura Mohammad
Published: May 2022

A woman in her 50s presented with uncontrolled hypertension, chest/back pain, paraplegia, right lower limb ischaemia and acute kidney injury. A CT angiogram demonstrated a type B aortic dissection originating distal to the left subclavian artery to bilateral common iliac arteries complicated by occlusion of the right renal artery and right common iliac artery. She was started on intravenous antihypertensive therapy and transferred to our institution for emergent thoracic endovascular aortic repair. Due to bleeding risk from coagulopathy, a spinal drain was not placed immediately post-operatively but instead was inserted after 24 hours while maintaining a mean arterial pressure of 80–100 mm Hg. Postoperatively, her right lower extremity perfusion was re-established, and her renal function recovered following temporary dialysis. At discharge on postoperative day 13, she regained full neurological function.
Rare paediatric case of agenesis of the vermiform appendix, ileal duplication and sickle cell disease
Authors: Laezza Nadia , Gião Nuno , Borges Cristina , Knoblich Maria
Published: May 2022

This study reports an exceptional case of a 14-year-old girl with sickle cell disease that was diagnosed with agenesis of the vermiform appendix and ileal duplication. Both consist of extremely rare gastrointestinal malformations whose association has never been described. The preadolescent girl presented with abdominal pain and vomiting, and the ultrasound was suggestive of acute appendicitis. Surgical findings were agenesis of the vermiform appendix and a T-shaped ileal malformation with inflammatory changes. The patient underwent resection and ileal end-to-end anastomosis. Histopathological evaluation identified an ileal duplication, with small bowel and colonic mucosa, no communication to the adjacent ileum and ischaemic changes. At 8-month follow-up, the patient was asymptomatic.
Intrahepatic renal cell carcinoma implantation along a percutaneous biopsy and cryoablation probe tract
Authors: Galambos David Maxwell , Salei Aliaksei , Rais-Bahrami Soroush , Varma Rakesh K
Published: May 2022

A man in his 60s underwent percutaneous biopsy and cryoablation of a right upper pole clear cell renal cell carcinoma followed by repeat cryoablation 8 months later for possible residual disease. The patient was followed with imaging with documented stability for 19 months after repeat ablation. However, imaging at 32 months demonstrated intrahepatic nodular enhancing lesions along the initial percutaneous biopsy and ablation tract, consistent with metastatic implantation. The patient underwent repeat percutaneous biopsy and two rounds of microwave ablation for treatment of the intrahepatic implants, with no residual disease at 10 months postablation. While needle tract seeding is a known complication of percutaneous manipulation of various abdominopelvic malignancies, there have been no prior reports of intrahepatic metastatic implants related to percutaneous renal cell carcinoma ablation. Awareness of this potential complication is important for treatment planning, informed consent and surveillance. This report shares our experience of the management of intrahepatic metastatic implants.
Takotsubo cardiomyopathy in the setting of thyroid storm
Authors: Sia Robin WJ , Sutherland Nigel , Wong Chiew , Sharma Naveen
Published: May 2022

A woman in her 50s with a background of chronic obstructive pulmonary disease secondary to smoking presented with intermittent chest tightness, dyspnoea and vomiting for 4 days. A presumed diagnosis of acute coronary syndrome (ACS) was made based on dynamic ischaemic ECG changes and elevation in high-sensitivity cardiac troponin T levels. She underwent emergent coronary angiography which demonstrated mild coronary artery disease with left ventriculography suggestive of mid-wall variant Takotsubo cardiomyopathy. Thyroid function tests performed to investigate sinus tachycardia were consistent with hyperthyroidism, and her thyroid-stimulating hormone receptor antibody was elevated. A diagnosis of thyroid storm was made in the setting of a newly diagnosed Graves’ disease and the patient was subsequently commenced on guideline-based therapy. This case demonstrates that Takotsubo cardiomyopathy, a mimic of ACS, is a possible complication of thyroid storm and therefore hyperthyroidism should be considered in the list of differentials in patients presenting with Takotsubo cardiomyopathy.
Intraoperative acute compartment syndrome of the upper limb secondary to extravasation
Authors: Ang Andrew , Michaelides Athena , Hallworth Stephen , Kocher Hemant M
Published: May 2022

A woman in her 50s was undergoing a repeat liver resection surgery for recurrence of liver metastasis when the intravenous fluid flow was noted to be sluggish on multiple occasions. On the third examination of the right hand where the intravenous cannula was located, surgery was halted as there was extensive swelling from the hand to the biceps and the hand had started turning blue. A diagnosis of acute upper limb compartment syndrome secondary to extravasation exacerbated by metaraminol was made by the anaesthetist and surgeon. Fasciotomies of the right upper limb were performed, and perfusion was restored. A hand surgeon arrived shortly after and completed decompressing the upper limb compartments.

A literature review revealed risk factors such as communication barriers, age and chemotherapy were present in this case. Enhanced monitoring is needed in the context of unsatisfactory infusion flow rates perioperatively.
Multisystem inflammatory syndrome in an adult with severe hypoxaemia and thyroiditis responsive to corticosteroid and interleukin 6 inhibitor treatment
Authors: Rojnukoolwanich Thitirat , Kuagoolwongse Chankanok , Vibhagool Asda , Pongpirul Krit
Published: May 2022

Multisystem inflammatory syndrome in adults (MIS-A) has been reported as a rare but severe consequence of COVID-19 infection. Adult patients were more likely to present with hypotension and cardiac illness when compared with multisystem inflammatory syndrome in children. Although the exact prevalence of MIS-A is unknown, more cases have been observed in men and younger adults. The pathophysiology of MIS-A is also unclear, but is thought to be caused by a delayed, dysregulated immune response. Given no established guideline for treatment of MIS-A, treatment has been based on case reports. We present a case of MIS-A in a woman in her 60s who had severe hypotension, progressive dyspnoea, massive pleural effusion, hypoxaemia, thyroiditis and multiple organ failure, which dramatically improved after treatment with corticosteroid and interleukin 6 inhibitor.
Chronic lymphoedema: a nidus for squamous cell carcinoma
Authors: Gulati Shrea , Chandrashekhara Sheragaru Hanumanthappa , Bhoriwal Sandeep , Kose Snehal Ishwar
Published: May 2022

Lymphoedema is a chronic debilitating condition characterised by diffuse swelling caused by lymphatic obstruction. The secondary form of lymphoedema is more common than the primary form. Untreated filariasis remains an important cause of lymphoedema in developing countries. The most common complication of chronic lymphoedema is cellulitis. It is also a risk factor for the development of neoplasms such as lymphangiosarcoma, squamous cell carcinoma, melanoma, lymphoma and malignant fibrous histiocytoma. We report a case of a woman in her 60s who developed squamous cell carcinoma in the background of chronic lymphoedema.
Malignant mixed tumour of the parotid gland in a preterm neonate with cytomegalovirus infection
Authors: Suleiman Riham , Darwish Tuka , Shamma Hadeel , Safadi Mhd Firas
Published: May 2022

A young pregnant woman presented to the emergency department with acute lower abdominal pain. The ultrasound examination showed not only a viable fetus with a gestational age of 24 weeks but also a heteroechoic mass of about 7×7 cm involving parts of the face. The patient was found to be in active labour with rapid progression, and she gave birth to a dead female neonate. The autopsy showed a large malignant mixed tumour of the left parotid gland and revealed infection with cytomegalovirus. To our knowledge, this is the first reported case of a malignant mixed tumour of salivary glands in fetuses.
Isolated soft tissue mass of the finger as the first presentation of oligometastatic renal cell carcinoma
Authors: Hopkins David T , Waters Darragh , Manecksha Rustom P , Lynch Thomas H
Published: May 2022

A man in his 70s was referred to plastic surgery with a suspected foreign body in the pulp of his right index finger. An excisional biopsy was performed for a presumed foreign body granuloma. Histology revealed metastatic renal cell carcinoma (mRCC). CT imaging demonstrated a 7.4 cm heterogeneous mass arising from the upper pole of the left kidney consistent with primary renal malignancy, in addition to a 9 mm lung nodule. He underwent an uncomplicated left laparoscopic cytoreductive nephrectomy and made a satisfactory recovery. To our knowledge, this is the first reported case of primary mRCC presenting with digital soft tissue metastasis. Cytoreductive nephrectomy with metastasectomy is the preferred management for mRCC where feasible. For unfavourable mRCC cases, first-line systemic therapy is indicated. Adjuvant systemic therapy in mRCC is currently limited to clinical trials, though promising data emerging on the use of pembrolizumab may herald a future shift in practice.
Successful rechallenge after clozapine-associated myocarditis
Authors: Holden John , Begum Milia
Published: May 2022

Clozapine is a highly effective medication used in management of treatment-resistant schizophrenia. Clozapine-associated myocarditis (CAM) is a rare but increasingly recognised complication of clozapine titration. Following an episode of CAM, clinicians can face a challenging dilemma of balancing the risks of recurrent myocarditis against the harms of ongoing psychosis. We describe the case of a woman in her 60s who developed acute myocarditis during clozapine titration and was then cautiously rechallenged with a successful outcome.
Congenital true oesophageal diverticulum: a report and review of the literature
Authors: Prasad Gaurav , Jain Vishesh , Goel Prabudh , Agarwala Sandeep
Published: May 2022

Oesophageal diverticulum occurring secondary to motility disorders or gastro-oesophageal reflux disease (GERD) is common in adults but true congenital oesophageal diverticula are rare in infants and children. We present a case of a toddler boy who presented with dysphagia and vomiting after feeds after weaning was attempted starting at 6 months of age. Barium esophagogram revealed a diverticulum in the upper one-third of the oesophagus within the thoracic cavity. The child underwent multiple interventions elsewhere without definitive surgery that highlights the rarity of this condition. Thoracotomy and repair were performed by us with a satisfactory outcome. The review of the literature on the clinical presentation and management of this rare condition has been discussed, highlighting similar reported cases.
Postpartum bilateral lung transplantation in COVID-19 associated respiratory failure
Authors: Vadlamudi Gayathri Devi , Keerthy Madhurima , Goyert Gregory
Published: May 2022

In critically ill patients with COVID-19, established therapies in the setting of respiratory failure include invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). This case report describes a pregnant woman in her 30s who was hospitalised at 35 weeks gestation with moderate COVID-19 disease. Her condition worsened following delivery, and she required intubation, maximum ventilatory support and ECMO. Because of the severe and irreversible nature of her lung disease, she ultimately underwent bilateral lung transplantation. This case showcases lung transplantation as an alternative life-saving option for patients with severe COVID-19 associated respiratory failure refractory to ECMO and mechanical ventilation. Further studies are needed to develop a multidisciplinary approach for patient selection for transplantation within the context of COVID-19 and to assess long-term outcomes.
Granulocyte colony-stimulating factor as a cause of acute leucocytoclastic vasculitis with anti-Ro and anti-La antibodies
Authors: Ji-Xu Antonio , Carroll Liam , Bentley Thomas , Jarrett Rachael
Published: May 2022

Granulocyte colony-stimulating factor (G-CSF) administration is associated with a diverse range of cutaneous sequelae. Serious dermatological side effects of G-CSF include the development of Sweet’s syndrome and exacerbations of pre-existing inflammatory disorders such as psoriasis. Here, we describe a report of acute leucocytoclastic vasculitis caused by G-CSF therapy associated with anti-Ro and anti-La antibodies in a patient with multiple myeloma. This case highlights the importance of having a high index of suspicion for acute leucocytoclastic vasculitis in patients with haematological malignancies undergoing G-CSF therapy.
Migration of vascular embolisation material from the intravascular space to surrounding interstitial tissues in arteriovenous malformations
Authors: Patel Rohini J , Cosman Bard C , Owens Erik L , Malas Mahmoud B
Published: May 2022

We present the case of a young man active duty in the military who initially presented with pelvic pain and fullness during sexual activity. Extensive workup showed a large pelvic arteriovenous malformation (AVM). He underwent over 10 interventional radiology procedures to embolise his AVM and suffered multiple postoperative complications resulting in exploratory laparotomies, bowel resections and ultimately a colostomy. Six years after his embolisation procedures, he was found on imaging to have gluteal fluid collections with metallic particles, presumed to be migrated Onyx from his angioembolisations as a result of non-target embolisation. Current literature does not document other instances of Onyx material migrating from an intravascular source to interstitial tissue.
Solitary fibrous tumour of lacrimal sac masquerading as lacrimal sac mucocele: a diagnostic and surgical dilemma
Authors: Panda Bijnya Birajita , Viswanath Shilpa , Baisakh Manas , Rauta Sudhasmita
Published: May 2022

Swellings in medial canthal area in eye most often involve the lacrimal sac, the commonest aetiology being chronic dacryocystitis. Very rarely, there is a deviation in the routine diagnosis when the pathology comes out to be a lacrimal sac tumour. We report the case of a young man who presented with a medial canthal mass not extending above the medial canthal ligament. The clinical presentation was typical for a lacrimal sac mucocele, however on histopathological evaluation was diagnosed as a rare case of solitary fibrous tumour of lacrimal sac. We recommend radiological investigation in medial canthal masses where there is negative regurgitation on pressure over lacrimal sac area to avoid misdiagnoses.
Choriocapillaris flow deficit and the risk of referable diabetic retinopathy: a longitudinal SS-OCTA study
Authors: Wang Wei , Cheng Weijing , Yang Shaopeng , Chen Yifan , Zhu Zhuoting , Huang Wenyong
Published: May 2022

Aims

To investigate the association between the choriocapillaris flow deficit percentage (CC FD%) and the 1-year incidence of referable diabetic retinopathy (RDR) in participants with type 2 diabetes mellitus (DM).

Methods

This prospective cohort study included participants with type 2 DM. The DR status was graded based on the ETDRS-7 photography. The CC FD% in the central 1 mm area, inner circle (1.5 mm to 2.5 mm), outer circle (2.5 mm to 5.0 mm) and the entire area in the macular region were measured using swept-source optical coherence tomography angiography (SS-OCTA). Logistic regression analysis was used to examine the association between baseline CC FD% and 1-year incident RDR.

Results

A total of 1222 patients (1222 eyes, mean age: 65.1±7.4 years) with complete baseline and 1-year follow-up data were included. Each 1% increase in baseline CC FD% was significantly associated with a 1.69 times (relative risk 2.69; 95% CI 1.53 to 4.71; p=0.001) higher odds for development of RDR after 1-year follow-up, after adjusting for other confounding factors.

Conclusions

A greater baseline CC FD% detected by SS-OCTA reliably predicted higher risks of RDR in participants with type 2 DM. Thus, CC FD% may act as a novel biomarker for predicting the onset and progression of DR.
Workflow and treatment results for computer-aided design and 3D-printed conformer therapy of congenital anophthalmia and microphthalmia
Authors: Groot Annabel L W , Remmers Jelmer S , Lissenberg-Witte Birgit I , de Meulenaere Simon T J , Talan Duygu , Liberton Niels P T J , de Graaf Pim , Moll Annette C , Saeed Peerooz , Hartong Dyonne T
Published: May 2022

Background/aims

To evaluate treatment with custom, three-dimensional (3D) printed conformers for socket expansion in congenital microphthalmia and anophthalmia (MICA).

Methods

Retrospective analysis of prospective cohort from 2016 to 2020. All children received custom-made 3D-printed conformers increasing in size. We measured height, width, thickness, surface and volume of first and consecutive conformers, as well as horizontal palpebral fissure length (HPF) at start and follow-up visits. We analysed these parameters for severely (<45%) and moderately (>45%–75%) affected children, based on affected axial length on ultrasonography.

Results

We included 18 cases (9 severe, 9 moderate) with a total of 174 conformers (88 severe, 86 moderate) and a mean follow-up of 2.8 years (range 1.3–4.8). The mean relative HPF increased from 77% to 93% with 16/17 cases reaching >80%, and 12/17 cases >90% symmetry. Horizontal and vertical conformer dimensions increased up to 10 months of treatment, with a steeper slope for the severe group (10.5% vs 5.5% for height and 9.0% vs 6.1% for width gain per treatment month, for severe and moderate MICA, respectively). After 10 months of treatment conformer height and width increased only slightly. No serious complications were observed.

Conclusion

3D-design and printing of solid conformers results in highly acceptable horizontal eyelid symmetry in the treatment of congenital MICA. The mean increase in conformer height and width in the first 10 months should be about 170% for moderate and about 200% for severe MICA. The presented conformer size formulas can aid ophthalmologists and ocularists to plan conformer treatment.
Prehospital interventions and neurological outcomes in marathon-related sudden cardiac arrest using a rapid mobile automated external defibrillator system in Japan: a prospective observational study
Authors: Tanaka Hideharu , Kinoshi Tomoya , Tanaka Shota , Sagisaka Ryo , Takahashi Hiroyuki , Sone Etsuko , Hara Takahiro , Takeda Yui , Takyu Hiroshi
Published: May 2022

Objective

To describe neurological outcomes after sudden cardiac arrests (SCAs) in road and long-distance races using a rapid mobile automated external defibrillator system (RMAEDS) intervention.

Methods

A total of 42 SCAs from 3 214 701 runners in 334 road and long-distance races from 1 February 2007 to 29 February 2020 were examined. Demographics, SCA interventions, EMS-related data and SCA-related outcomes were measured. Primary endpoints were favourable neurological outcomes (Cerebral Performance Categories 1–2) at 1-month and 1-year post-SCA. Secondary endpoints were factors related to the field return of spontaneous circulation (ROSC) and resuscitation characteristics, including the initial ECG waveform classification and resuscitation sequence times according to the initial ECG rhythm.

Results

The SCA incidence rate was 1.31 per 100 000 runners (age: median (IQR), 51 (36.5, 58.3) years). Field ROSC and full neurological recovery at 1-month post-SCA was achieved 90.4% and 92.9% of cases, respectively. In 22 cases in which bystander cardiopulmonary resuscitation was initiated within 1 min and defibrillation performed within 3 min, full neurological recovery was achieved at 1-month and 1-year post-SCA in 95.5.% and 95.5% of cases, respectively.

Conclusions

The RMAEDS successfully treated patients with SCA during road and long-distance races yielding a high survival rate and favourable neurological outcomes. These findings support rapid intervention and the proper placement of healthcare teams along the race course to initiate chest compressions within 1 min and perform defibrillation within 3 min.
Continuous glucose monitoring demonstrates low risk of clinically significant hypoglycemia associated with sulphonylurea treatment in an African type 2 diabetes population: results from the OPTIMAL observational multicenter study
Authors: Niwaha Anxious J , Rodgers Lauren R , Carr Alice L J , Balungi Priscilla A , Mwebaze Raymond , Hattersley Andrew T , Shields Beverley M , Nyirenda Moffat J , Jones Angus G
Published: May 2022

Introduction

People living with diabetes in low-resource settings may be at increased hypoglycemia risk due to food insecurity and limited access to glucose monitoring. We aimed to assess hypoglycemia risk associated with sulphonylurea (SU) and insulin therapy in people living with type 2 diabetes in a low-resource sub-Saharan African setting.

Research design and methods

This study was conducted in the outpatients’ diabetes clinics of two hospitals (one rural and one urban) in Uganda. We used blinded continuous glucose monitoring (CGM) and self-report to compare hypoglycemia rates and duration in 179 type 2 diabetes patients treated with sulphonylureas (n=100) and insulin (n=51) in comparison with those treated with metformin only (n=28). CGM-assessed hypoglycemia was defined as minutes per week below 3mmol/L (54mg/dL) and number of hypoglycemic events below 3.0 mmol/L (54 mg/dL) for at least 15 minutes.

Results

CGM recorded hypoglycemia was infrequent in SU-treated participants and did not differ from metformin: median minutes/week of glucose <3 mmol/L were 39.2, 17.0 and 127.5 for metformin, sulphonylurea and insulin, respectively (metformin vs sulphonylurea, p=0.6). Hypoglycemia risk was strongly related to glycated haemoglobin (HbA1c) and fasting glucose, with most episodes occurring in those with tight glycemic control. After adjusting for HbA1c, time <3 mmol/L was 2.1 (95% CI 0.9 to 4.7) and 5.5 (95% CI 2.4 to 12.6) times greater with sulphonylurea and insulin, respectively, than metformin alone.

Conclusions

In a low-resource sub-Saharan African setting, hypoglycemia is infrequent among people with type 2 diabetes receiving sulphonylurea treatment, and the modest excess occurs predominantly in those with tight glycemic control.
Serum metabolomic signatures of gestational diabetes in South Asian and white European women
Authors: Sikorski Claudia , Azab Sandi , de Souza Russell J , Shanmuganathan Meera , Desai Dipika , Teo Koon , Atkinson Stephanie A , Morrison Katherine , Gupta Milan , Britz-McKibbin Philip , Anand Sonia S
Published: May 2022

Introduction

This study aimed to identify serum metabolomic signatures associated with gestational diabetes mellitus (GDM), and to examine if ethnic-specific differences exist between South Asian and white European women.

Research design and methods

Prospective cohort study with a nested case–control analysis of 600 pregnant women from two Canadian birth cohorts; using an untargeted approach, 63 fasting serum metabolites were measured and analyzed using multisegment injection-capillary electrophoresis-mass spectrometry. Multivariate logistic regression modeling was conducted overall and by cohort.

Results

The proportion of women with GDM was higher in South Asians (27.1%) compared with white Europeans (17.9%). Several amino acid, carbohydrate, and lipid pathways related to GDM were common to South Asian and white European women. Elevated circulating concentrations of glutamic acid, propionylcarnitine, tryptophan, arginine, 2-hydroxybutyric acid, 3-hydroxybutyric acid, and 3-methyl-2-oxovaleric acid were associated with higher odds of GDM, while higher glutamine, ornithine, oxoproline, cystine, glycine with lower odds of GDM. Per SD increase in glucose concentration, the odds of GDM increased (OR=2.07, 95% CI 1.58 to 2.71), similarly for metabolite ratios: glucose to glutamine (OR=2.15, 95% CI 1.65 to 2.80), glucose to creatinine (OR=1.79, 95% CI 1.39 to 2.32), and glutamic acid to glutamine (OR=1.46, 95% CI 1.16 to 1.83). South Asians had higher circulating ratios of glucose to glutamine, glucose to creatinine, arginine to ornithine, and citrulline to ornithine, compared with white Europeans.

Conclusions

We identified a panel of serum metabolites implicated in GDM pathophysiology, consistent in South Asian and white European women. The metabolic alterations leading to larger ratios of glucose to glutamine, glucose to creatinine, arginine to ornithine, and citrulline to ornithine in South Asians likely reflect the greater burden of GDM among South Asians compared with white Europeans.
Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic
Authors: Ali Namam , El Hamdaoui Soumia , Nefs Giesje , Tack Cornelis J , De Galan Bastiaan E
Published: May 2022

Introduction

Various studies have shown a number of glycemic parameters to improve over several weeks in people with type 1 diabetes during the first surge of the COVID-19 pandemic. Whether and to what extent such improvement is sustained during following COVID-19 surges remains unknown. Therefore, the aim of this study was to investigate glycemic parameters during the first year of the COVID-19 pandemic in people with type 1 diabetes and to determine factors associated with glycemic improvement.

Research design and methods

This was an observational cohort study in people with type 1 diabetes, aged ≥16 years. We compared glycated hemoglobin (HbA1c) and flash glucose monitoring (FGM) downloads between the prelockdown period and approximately 1 year thereafter. Using logistic regression analysis, we assessed associations between an HbA1creduction of at least 0.5% (~5.5 mmol/mol) with baseline clinical characteristics and self-reported changes in psychological well-being and lifestyle behavior related to COVID-19.

Results

A total of 437 participants were included. As compared with prepandemic data, 1 year after the start of the COVID-19 pandemic and associated lockdowns, HbA1chad decreased from 7.9%±1.1% (63±12 mmol/mol) to 7.5%±1.0% (59±11 mmol/mol) (p<0.001), whereas time in range increased from 55.8%±16.7% to 58.6%±16.7% (p=0.004) and time below (<3.9 mmol/L) and above (>13.9 mmol/L) range and glucose variability all decreased (all p<0.05). FGM use, higher HbA1cat baseline and current smoking were independently associated with an HbA1cdecrease of at least 0.5%, whereas self-reported changes in psychological well-being and lifestyle behavior related to the first surge of the COVID-19 pandemic and associated lockdowns were not.

Conclusions

The COVID-19 pandemic and related lockdown measures were associated with improvement in glucometrics, including HbA1cand FGM data, in individuals with type 1 diabetes, particularly in FGM users, those with higher HbA1cat baseline or current smokers.
Lost microbes of COVID-19:Bifidobacterium,Faecalibacteriumdepletion and decreased microbiome diversity associated with SARS-CoV-2 infection severity
Authors: Hazan Sabine , Stollman Neil , Bozkurt Huseyin S , Dave Sonya , Papoutsis Andreas J , Daniels Jordan , Barrows Brad D , Quigley Eamonn MM , Borody Thomas J
Published: May 2022

Objective

The study objective was to compare gut microbiome diversity and composition in SARS-CoV-2 PCR-positive patients whose symptoms ranged from asymptomatic to severe versus PCR-negative exposed controls.

Design

Using a cross-sectional design, we performed shotgun next-generation sequencing on stool samples to evaluate gut microbiome composition and diversity in both patients with SARS-CoV-2 PCR-confirmed infections, which had presented to Ventura Clinical Trials for care from March 2020 through October 2021 and SARS-CoV-2 PCR-negative exposed controls. Patients were classified as being asymptomatic or having mild, moderate or severe symptoms based on National Institute of Health criteria. Exposed controls were individuals with prolonged or repeated close contact with patients with SARS-CoV-2 infection or their samples, for example, household members of patients or frontline healthcare workers. Microbiome diversity and composition were compared between patients and exposed controls at all taxonomic levels.

Results

Compared with controls (n=20), severely symptomatic SARS-CoV-2-infected patients (n=28) had significantly less bacterial diversity (Shannon Index, p=0.0499; Simpson Index, p=0.0581), and positive patients overall had lower relative abundances ofBifidobacterium(p<0.0001),Faecalibacterium(p=0.0077) andRoseburium(p=0.0327), while having increasedBacteroides(p=0.0075). Interestingly, there was an inverse association between disease severity and abundance of the same bacteria.

Conclusion

We hypothesise that low bacterial diversity and depletion ofBifidobacteriumgenera either before or after infection led to reduced proimmune function, thereby allowing SARS-CoV-2 infection to become symptomatic. This particular dysbiosis pattern may be a susceptibility marker for symptomatic severity from SARS-CoV-2 infection and may be amenable to preinfection, intrainfection or postinfection intervention.

Trial registration number

NCT04031469(PCR−) and 04359836 (PCR+).
Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome
Authors: Watson Samuel I , Rego Ryan T T , Hofer Timothy , Lilford Richard J
Published: May 2022

Water, sanitation and hygiene interventions have been the subject of cluster trials of unprecedented size, scale and cost in recent years. However, the question ‘what works in water, sanitation, hygiene (WASH)?’ remains poorly understood. Evaluations of community interventions to prevent infectious disease typically use lab-confirmed infection as a primary outcome; however, WASH trials mostly use reported diarrhoea. While diarrhoea is a significant source of morbidity, it is subjected to significant misclassification error with respect to enteric infection due to the existence of non-infectious diarrhoea and asymptomatic infection. We show how this may lead to bias of estimated effects of interventions from WASH trials towards no effect. The problem is further compounded by other biases in the measurement process. Alongside testing for infection of the gut, an examination of the causal assumptions underlying WASH interventions present several other reliable alternative and complementary measurements and outcomes. Contemporary guidance on the evaluation of complex interventions requires researchers to take a broad view of the causal effects of an intervention across a system. Reported diarrhoea can fail to even be a reliable measure of changes to gastrointestinal health and so should not be used as a primary outcome if we are to progress our knowledge of what works in WASH.
Global developments in social prescribing
Authors: Morse Daniel F , Sandhu Sahil , Mulligan Kate , Tierney Stephanie , Polley Marie , Chiva Giurca Bogdan , Slade Siân , Dias Sónia , Mahtani Kamal R , Wells Leanne , Wang Huali , ‍Zhao Bo , De Figueiredo Cristiano Emanuel Marta , Meijs Jan Joost , Nam Hae Kweun , Lee Kheng Hock , Wallace Carolyn , Elliott Megan , Mendive Juan Manuel , Robinson David , Palo Miia , Herrmann Wolfram , Østergaard Nielsen Rasmus , Husk Kerryn
Published: May 2022

Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the ‘Beyond the Building Blocks’ framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs.
Youth social innovation during the COVID-19 pandemic in the Philippines: a quantitative and qualitative descriptive analyses from a crowdsourcing open call and online hackathon
Authors: Ulitin Allan , Mier-Alpaño Jana Deborah , Labarda Meredith , Juban Noel , Mier Abigail Ruth , Tucker Joseph D , Tang Weiming , Auplish Mallika , Chan Po-lin
Published: May 2022

Introduction

Young people have played a pivotal role as part of the COVID-19 response, including developing health messages and social innovations. Social innovation in health engages multiple stakeholders in linking social change and health improvement. The study examined the feasibility of youth ideas and innovations to address the impacts of the COVID-19 pandemic using quantitative and qualitative descriptive analyses.

Methods

In partnership with the WHO, academic institutions, youth organisations and civil society groups, we conducted a crowdsourcing open call among Filipino youth (15–30 years old) using a structured Special Programme for Research and Training in Tropical Diseases/Social Innovation in Health Initiative process. The open call had three categories:youth voices to cocreate the post-COVID-19 world(entries were texts, images, videos and music),youth-led COVID-19 social innovations, andyouth-led social innovations not related to COVID-19. Each submission was evaluated by three independent judges. Finalists were selected in each of the categories alongside four grand winners. All finalists were invited to attend a 1 day online civic hackathon.

Results

We received a total of 113 entries (youth voices to cocreate the post-COVID world=76;youth-led COVID-19 social innovations=17;youth-led social innovations not related to COVID-19=20). Twelve entries focused on youth mental health during the pandemic. The online hackathon provided the participants mentorship for further development of their ideas. Finalists were able to produce draft health communication campaigns and improved social innovations.

Conclusion

Many Filipino youth created exceptional entries in response to the open call. This suggests the feasibility of including youth voices in strategic planning processes. A global youth social innovation call is recommended.
‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios
Authors: Ekstedt Mirjam , Schildmeijer Kristina , Backåberg Sofia , Ljungholm Linda , Fagerström Cecilia
Published: May 2022

Objective

Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.

Design

A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.

Setting

Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.

Participants

Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.

Results

Home care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.

Conclusions

Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.
Diagnostic accuracy of code-free deep learning for detection and evaluation of posterior capsule opacification
Authors: Huemer Josef , Kronschläger Martin , Ruiss Manuel , Sim Dawn , Keane Pearse A , Findl Oliver , Wagner Siegfried K
Published: May 2022

Objective

To train and validate a code-free deep learning system (CFDLS) on classifying high-resolution digital retroillumination images of posterior capsule opacification (PCO) and to discriminate between clinically significant and non-significant PCOs.

Methods and analysis

For this retrospective registry study, three expert observers graded two independent datasets of 279 images three separate times with no PCO to severe PCO, providing binary labels for clinical significance. The CFDLS was trained and internally validated using 179 images of a training dataset and externally validated with 100 images. Model development was through Google Cloud AutoML Vision. Intraobserver and interobserver variabilities were assessed using Fleiss kappa (κ) coefficients and model performance through sensitivity, specificity and area under the curve (AUC).

Results

Intraobserver variability κ values for observers 1, 2 and 3 were 0.90 (95% CI 0.86 to 0.95), 0.94 (95% CI 0.90 to 0.97) and 0.88 (95% CI 0.82 to 0.93). Interobserver agreement was high, ranging from 0.85 (95% CI 0.79 to 0.90) between observers 1 and 2 to 0.90 (95% CI 0.85 to 0.94) for observers 1 and 3. On internal validation, the AUC of the CFDLS was 0.99 (95% CI 0.92 to 1.0); sensitivity was 0.89 at a specificity of 1. On external validation, the AUC was 0.97 (95% CI 0.93 to 0.99); sensitivity was 0.84 and specificity was 0.92.

Conclusion

This CFDLS provides highly accurate discrimination between clinically significant and non-significant PCO equivalent to human expert graders. The clinical value as a potential decision support tool in different models of care warrants further research.
Remote exposure to secondhand tobacco smoke is associated with lower exercise capacity through effects on oxygen pulse, a proxy of cardiac stroke volume
Authors: Zeng Siyang , Dunn Michelle , Gold Warren M , Kizer Jorge R , Arjomandi Mehrdad
Published: May 2022

Background

Past exposure to secondhand tobacco smoke (SHS) is associated with exercise limitation. Pulmonary factors including air trapping contribute to this limitation but the contribution of cardiovascular factors is unclear.

Objective

To determine the contribution of cardiovascular mechanisms to SHS-associated exercise limitation.

Methods

We examined the cardiovascular responses to maximum-effort exercise in 245 never-smokers with remote, prolonged occupational exposure to SHS and no known history of cardiovascular disease. We estimated the contribution of oxygen-pulse (proxy for cardiac stroke volume) and changes in systolic blood pressures (SBP), diastolic blood pressures and heart rate (HR) towards exercise capacity, and examined whether the association of SHS with exercise capacity was mediated through these variables.

Results

At peak exercise (highest workload completed (WattsPeak)=156±46 watts (135±33 %predicted)), oxygen consumption and oxygen-pulse (O2-PulsePeak) were 1557±476 mL/min (100±24 %predicted) and 11.0±3.0 mL/beat (116±25 %predicted), respectively, with 29% and 3% participants not achieving their predicted normal range. Oxygen saturation at peak exercise was 98%±1% and remained >93% in all participants. Sixty-six per cent showed hypertensive response to exercise. In models adjusted for covariates, WattsPeakwas associated directly with O2-PulsePeak, HRPeakand SBPPeakand inversely with SHS, air trapping (residual volume/total lung capacity) and rise of SBP over workload (all p<0.01). Moreover, SHS exposure association with WattsPeakwas substantially (41%) mediated through its effect on O2-PulsePeak(p=0.038). Although not statistically significant, a considerable proportion (36%) of air trapping effect on WattsPeakseemed to be mediated through O2-PulsePeak(p=0.078). The likelihood of having baseline respiratory symptoms (modified Medical Research Council score ≥1) was associated with steeper rise in SBP over workload (p<0.01).

Conclusion

In a never-smoker population with remote exposure to SHS, abnormal escalation of blood pressure and an SHS-associated reduction in cardiac output contributed to lower exercise capacity.
Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2×2 partial factorial, randomised controlled trial
Authors: Chang Anne B , Morgan Lucy C , Duncan Emma L , Chatfield Mark D , Schultz André , Leo Paul J , McCallum Gabrielle B , McInerney-Leo Aideen M , McPhail Steven M , Zhao Yuejen , Kruljac Catherine , Smith-Vaughan Heidi C , Morris Peter S , Marchant Julie M , Yerkovich Stephanie T , Cook Anne L , Wurzel Danielle , Versteegh Lesley , O’Farrell Hannah , McElrea Margaret S , Fletcher Sabine , D'Antoine Heather , Stroil-Salama Enna , Robinson Phil J , Grimwood Keith
Published: May 2022

Introduction

Primary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated from people with cystic fibrosis. Our planned RCT seeks to address some of these unmet needs by employing a currently prescribed (but unapproved for long-term use in PCD) macrolide antibiotic (azithromycin) and a novel mucolytic agent (erdosteine). The primary aim of our RCT is to determine whether regular oral azithromycin and erdosteine over a 12-month period reduces acute respiratory exacerbations among children and adults with PCD. Our primary hypothesis is that: people with PCD who regularly use oral azithromycin and/or erdosteine will have fewer exacerbations than those receiving the corresponding placebo medications. Our secondary aims are to determine the effect of the trial medications on PCD-specific quality-of-life (QoL) and other clinical outcomes (lung function, time-to-next exacerbation, hospitalisations) and nasopharyngeal bacterial carriage and antimicrobial resistance.

Methods and analysis

We are currently undertaking a multicentre, double-blind, double-dummy RCT to evaluate whether 12 months of azithromycin and/or erdosteine is beneficial for children and adults with PCD. We plan to recruit 104 children and adults with PCD to a parallel, 2×2 partial factorial superiority RCT at five sites across Australia. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, lung function and nasopharyngeal carriage by respiratory bacterial pathogens and their associated azithromycin resistance.

Ethics and dissemination

Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation and National Health and Medical Research Council guidelines for ethical conduct of Research, including that for First Nations Australians.

Trial registration number

ACTRN12619000564156.
Predicting lying, sitting and walking at different intensities using smartphone accelerometers at three different wear locations: hands, pant pockets, backpack
Authors: Khataeipour Seyed Javad , Anaraki Javad Rahimipour , Bozorgi Arastoo , Rayner Machel , A Basset Fabien , Fuller Daniel
Published: May 2022

Objective

This study uses machine learning (ML) to develop methods for estimating activity type/intensity using smartphones, to evaluate the accuracy of these models for classifying activity, and to evaluate differences in accuracy between three different wear locations.

Method

Forty-eight participants were recruited to complete a series of activities while carrying Samsung phones in three different locations: backpack, right hand and right pocket. They were asked to sit, lie down, walk and run three Metabolic Equivalent Task (METs), five METs and at seven METs. Raw accelerometer data were collected. We used the R, activity counts package, to calculate activity counts and generated new features based on the raw accelerometer data. We evaluated and compared several ML algorithms; Random Forest (RF), Support Vector Machine, Naïve Bayes, Decision Tree, Linear Discriminant Analysis and k-Nearest Neighbours using the caret package (V.6.0–86). Using the combination of the raw accelerometer data and the computed features leads to high model accuracy.

Results

Using raw accelerometer data, RF models achieved an accuracy of 92.90% for the right pocket location, 89% for the right hand location and 90.8% for the backpack location. Using activity counts, RF models achieved an accuracy of 51.4% for the right pocket location, 48.5% for the right hand location and 52.1% for the backpack location.

Conclusion

Our results suggest that using smartphones to measure physical activity is accurate for estimating activity type/intensity and ML methods, such as RF with feature engineering techniques can accurately classify physical activity intensity levels in laboratory settings.