bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative pain management in pediatric cleft lip and palate repair
Authors: Flowers Thomas , Winters Ryan
Published: May 2021

Purpose of review

There has been an increased interest in the literature on methods to improve perioperative outcomes in surgical patients while minimizing opioid use. Pediatric cleft palate repair can be a painful procedure, and this postoperative pain can lead to longer hospital stays and worse surgical outcomes.

Recent findings

Recent literature has explored four key areas surrounding analgesia after cleft lip and palate repair. These areas are management of postoperative pain with nonopioid oral analgesics, peripheral nerve blockade, liposomal bupivacaine for donor-site analgesia in bone grafting, and enhanced recovery after surgery (ERAS) protocols.

The included studies indicate that patients undergoing palatoplasty may have a decreased opioid requirement if nonopioid analgesics such as acetaminophen and ibuprofen are started early in the postoperative setting. Peripheral nerve blockade is an important adjunct to analgesia in these patients. Suprazygomatic maxillary nerve blockade may improve pain management over traditional infraorbital nerve blockade. In patients undergoing alveolar bone grafting, injection of liposomal bupivacaine into the donor site can significantly decrease oral opioid requirements. Finally, ERAS protocols are emerging ways to decrease postoperative pain in cleft palate patients.
Management of facial burns: an update
Authors: Abubakar Muhammad Lawal , Ibrahim Abdulrasheed
Published: May 2021

Purpose of review

This article reviews literature on the recent progress made on management of facial burns. The discussion focuses on those aspects of the management in which recent studies brought new ideas, and reviews some that failed to change practices in the management of facial burns.

Recent findings

Recent innovations and models have been proposed in an attempt to reduce the incidence of unnecessary intubations in patients with burns to the face and with suspected inhalational injury. However, the decision to secure the airway is still a challenging one. A new escharotomy method based on facial subunits principles has been described, while the practice of early tangential excision is still debated in the literature. Tarsorrhaphy without occluding the eyes has also been described in the management of peri-oral burns. Self-retaining and expandable stents for the nose have also been demonstrated to be effective in preventing nasal stenosis. 3D printed face masks have been more recently developed to improve the current wound-care methods used in facial scar management.

This article highlights recent developments in the management of facial burns in areas such as acute facial burn care, subsequent wound care and facial scar management. It highlights areas wherein progress has been made, as well as the need for further studies in certain areas.
Integrating Health at Every Size principles into adolescent care
Authors: Raffoul Amanda , Williams Lesley
Published: May 2021

Purpose of review

Weight trends continue to increase in adolescents, but current weight-focused interventions have not demonstrated any lasting impact on overall health. Among adolescents, experiencing weight bias increases risks of harmful weight-related behaviors and decreases engagement in health-promoting behaviors, thus leading to worsened health outcomes. The Health at Every Size (HAES) approach may be an avenue to promote health holistically among adolescents without eliciting harmful weight-related behavior and improving provider-patient rapport. The purpose of this review is to summarize the literature on integrating HAES principles into healthcare and to generate recommendations for healthcare providers.

Recent findings

Research among adults shows that HAES-informed care can improve some physical health measures and generates improvements in behavioral and psychological outcomes, as well as promotion of social justice and equity. HAES-informed recommendations for adolescent care de-emphasize weight loss and focus on removing barriers to engaging in health-promoting behaviors at the point of assessment, in the diagnosis and management of medical complications, and in treatment.

HAES principles can be an invaluable tool for providers who aim to improve overall health whilst avoiding a focus on weight among their clients.
Use of gonadotropin-releasing hormone analogs in children
Authors: Allen Natalie G. , Krishna Kanthi Bangalore , Lee Peter A.
Published: May 2021

Purpose of review

In this review, we outline the usage and formulations of gonadotropin-releasing hormone analogs (GnRHas) in central precocious puberty (CPP), short stature, and gender diverse individuals, as well as adverse effects, long-term outcomes, and monitoring of therapy. There is a particular focus on citing references published within the last 24 months.

Recent findings

Long-acting formulations of GnRHa now include Federal Drug Administration approval for subcutaneous injections. Significant adverse events continue to be rarely reported; extremely rare events include arterial hypertension and pseudotumor cerebri. There continue to be no significant long-term consequences including the impact upon body mass index and bone mineral density, which appear to be transient. GnRHas have been used in differences of sexual development (DSD) and increasingly in the treatment of adolescent transgender individuals.

GnRHas remain as the only fully efficacious therapy for CPP and effectively suppress pubertal hormones in other situations. The use of GnRHa therapy in gender incongruent individuals has proven beneficial and has become a standard of care, whereas use in those with DSDs should still be considered experimental.

Video abstract

http://links.lww.com/MOP/A62.
Multisystem Inflammatory Syndrome in a Pediatric Patient With Sickle Cell Disease and COVID-19: A Case Report
Authors: Español María G. , Gardner Renee V. , Alicea-Marrero Minelys M. , Marrero-Rivera Gisela , Bradford Tamara , LeBlanc Dana M. , Velez María C.
Published: May 2021

To this day, there are limited data about the effects and management of coronavirus disease infection in pediatric patients with sickle cell disease. We present the management and successful clinical course of an 8-year-old female with homozygous sickle cell disease (SS) and severe acute chest syndrome secondary to coronavirus disease 2019 infection, complicated by cortical vein thrombosis.
Thoracic Air Leak Syndrome, Pulmonary Aspergillosis, and COVID-19 Pneumonia After Allogeneic Stem Cell Transplantation in a Child With Myelodysplastic Syndrome
Authors: Sever Tayyibe , Kaya Zuhre , Kirkiz Serap , Celik Ali , Akdulum Ismail , Gürsoy Tugba R. , Aslan Ayse T. , Deniz Melis , Tapisiz Anil , Kocak Ulker
Published: May 2021

Thoracic air leak syndromes (TALS) are very rare among the noninfectious pulmonary complications (PCs). They can either be idiopathic or have several risk factors such as allogeneic hematopoietic stem cell transplantation (allo-HSCT), graft versus host disease and rarely pulmonary aspergillosis. We present a 14-year-old girl with hypoplastic myelodysplastic syndrome who developed graft versus host disease on day 60, TALS on day 150, bronchiolitis obliterans syndrome on day 300, pulmonary aspergillosis on day 400 and COVID-19 pneumonia on day 575 after allo-HSCT. This is the first report of a child who developed these subsequent PCs after allo-HSCT. Therefore, the manifestations of these unfamiliar PCs like TALS and COVID-19 pneumonia, and concomitant pulmonary aspergillosis with management options are discussed.
The Effect of a Discharge Disposition Algorithm on Patient Outcomes and Satisfaction
Authors: Heligman Jessica L.
Published: May 2021

Total joint arthroplasties are one of the most common procedures performed in the United States. As changes have occurred in the surgical techniques of these procedures, postoperative recovery time has decreased and patients have been able to safely transition to home rather than a post–acute care facility. The demand for total joint arthroplasty (TJA) is expected to grow 44% as the prevalence of lower extremity osteoarthritis continues to rise (Sher et al., 2017) because of an aging baby boomer population. In the next 20 years, it is expected that the demand for total hip arthroplasty will grow by 174% and demand for total knee arthroplasty will grow by as much as 670% (Napier et al., 2013). An area with high variability in the postoperative period is in postdischarge rehabilitation. Post–acute inpatient care can account for up to 36% of the bundled costs of a TJA. There is a lack of evidence that patients recover better or have decreased complications by transitioning to an inpatient rehabilitation setting compared with transitioning to home. The aims of this literature search were to (a) identify the safest discharge disposition for patients following TJA; (b) determine the rate of complications and readmissions among those discharged to skilled nursing facility, inpatient rehabilitation unit, and home; and (c) explore how specified care pathways affect patient expectations and outcomes. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Cochrane were searched using the following key terms: discharge disposition, total joint arthroplasty, joint replacement, hip arthroplasty, knee arthroplasty, care pathway, discharge outcomes and readmissions, discharge protocols, and discharge algorithms. Five key themes emerged. Patients with significant comorbidities may require longer length of stay in the hospital or potentially discharge to a facility, discharge to facility associated with high rate of complications, setting patient expectations increases likelihood of discharge home, discharge to inpatient facilities does not improve outcomes, and discharge to any post–acute care facility is more expensive than discharge to home. This review identified themes in postoperative care of TJA patients that can be utilized to create a discharge disposition algorithm using best practices to stratify patients into the appropriate discharge disposition while setting appropriate expectations for patients undergoing these procedures to ensure high levels of patient satisfaction following these procedures.
Causal Model of Psychological Empowerment Among People With Spinal Cord Injury in Thailand
Authors: Rattanasuk Dalin , Khuwatsamrit Kusuma
Published: May 2021

The purpose of this study was to develop and evaluate a causal model illustrating the relationships of age, education, physical impairment duration, social support, functional ability, and self-esteem with psychological empowerment in persons with spinal cord injury. Participants were 260 individuals admitted to a hospital in Thailand. Data were analyzed using path analysis (with the maximum likelihood estimation technique) in Linear Structural Relationship (LISREL). The study results revealed that age and education did not significantly influence psychological empowerment. However, self-esteem had a direct effect on psychological empowerment, whereas physical impairment duration, functional ability, and social support had indirect effects through self-esteem. These four predictors explained 64% of the total variance in this model of psychological empowerment for people with spinal cord injury. These findings can be used as a guideline for developing appropriate interventions to promote psychological empowerment among Thais with spinal cord injury.
The Effectiveness of a Senokot Cocktail for Postoperative Constipation
Authors: Blot Ella , Raz Merlita , Withall Jennifer , Link Lauren , Rich Ellen
Published: May 2021

A senior staff registered nurse on an orthopaedic inpatient rehabilitation unit in an urban orthopaedic hospital utilized a “cocktail” of warm prune juice, lemon juice, and Senokot liquid for patients who presented to the rehabilitation unit after orthopaedic surgery without having had an initial postoperative bowel movement (BM). A pilot study (n = 30) using a quasi-experimental design was conducted to evaluate the effect of the cocktail versus liquid Senokot alone on the first postoperative BM. Several measurement tools were used, including the Bristol Stool Scale, visual analog scales to determine pain and strain, and a BM quality scale. A small sample size became even smaller when only 80% of participants had a BM within the study time frame. Therefore, significant findings were difficult to establish. Additional research is needed to adequately assess the effect of the Senokot “cocktail” on postoperative constipation in the rehabilitation population.
The Effect of Balloon-Blowing Exercise on Postoperative Pulmonary Functions in Patients Undergoing Total Hip Arthroplasty
Authors: Kızılcık Özkan Zeynep , Yanık Fazlı , Ünver Seher , Yıldız Fındık Ümmü
Published: May 2021

General anesthesia, prolonged immobilization, and pain may adversely affect pulmonary function in patients undergoing prosthetic surgery. The aim of this study was to evaluate the effect of balloon-blowing exercises on pulmonary functions in patients undergoing total hip arthroplasty. The patients in the experimental group performed three sets of balloon-blowing exercises in the morning, at noon, and in the evening on the first to third days postoperatively. The increase in forced vital capacity (FVC) values between the control and experimental groups in the postoperative period was statistically significant (p < .001), in favor of the experimental group. The increase in forced expiratory volume during the first second (FEV1)/FVC ratio was found to be significantly higher in the experimental group than in the control group (p < .001). Patients who performed balloon-blowing exercises increased their FVC and FEV1/FVC ratio.
Benefit of Simulation-Based Training in Medical Adverse Events Disclosure in Pediatrics
Authors: Aubin Juliette , Rivolet Océane , Taunay Anne-Laure , Ragot Stéphanie , Ghazali Daniel Aiham , Oriot Denis
Published: May 2021

Introduction

Adverse events (AEs) in health care are a public health issue. Although mandatory, error disclosure is experienced by health providers as a difficult task.

Methods

In this prospective study, the primary objective was to assess performance in disclosing AEs to simulated parents using a validated scale before and after training among a pediatric residents' population. Secondary objectives were to assess correlation with year of residency, sex, and previous experience and to analyze gain in knowledge (theoretical pretest/posttest scores) and satisfaction. Two evaluation simulations (simulation [SIM] 1 and SIM 2) were scheduled at 3-week interval. In the intervention group, mastery learning was offered after SIM 1 including a didactic approach and a training session using role-playing games. For the control group, the course was carried out after SIM 2. Assessments were performed by 2 independent observers and simulated parents.

Results

Forty-nine pediatric residents performed 2 scenarios of AE disclosure in front of simulated parents. In the intervention group, performance scores on SIM 2 (72.36 ± 5.40) were higher than on SIM 1 (65.08 ± 9.89, P = 0.02). In the control group, there was no difference between SIM 1 and SIM 2 (P = 0.62). The subjective scores from simulated parents showed the same increase on SIM 2 (P < 0.01). There was no correlation with the residents' previous experience or their residency year. There was an increase in self-confidence (P = 0.04) for SIM 2. There was also an increase in posttest theoretical scores (P = 0.02), and residents were satisfied with the training.

Conclusions

This study showed the benefits of simulation-based training associated with mastery learning in AE disclosure among pediatric residents. It is important to train residents for these situations to avoid traumatic disclosure generating a loss of confidence of the family regarding physicians and possible lawsuits.
Prepectoral versus Subpectoral Tissue Expander Breast Reconstruction: A Historically Controlled, Propensity Score–Matched Comparison of Perioperative Outcomes
Authors: Haddock Nicholas T. , Kadakia Yash , Liu Yulun , Teotia Sumeet S.
Published: May 2021

Background:

The rising popularity of prepectoral tissue expander placement with acellular dermal matrices in immediate breast reconstruction has prompted many studies on the safety of this technique. However, a comprehensive propensity-matched, historically controlled trial comparing perioperative outcomes following prepectoral versus partial subpectoral (dual-plane) placement of tissue expanders is lacking.

Methods:

Retrospective propensity-matched cohort analysis was performed on all patients of two senior reconstructive surgeons who underwent bilateral tissue expander placement following a mastectomy with one of three breast surgeons at a single academic institution from 2012 onward (n = 260). Two matched groups (prepectoral and partial subpectoral) each consisted of 102 patients. Univariate and multivariable analyses were also performed to contextualize the risks associated with prepectoral reconstruction relative to demographic characteristics and other clinical factors.

Results:

Compared to dual-plane subpectoral placement, prepectoral placement resulted in similar rates of overall perioperative complications (32 percent versus 31 percent; p = 1.00) and perioperative complications that required operative treatment (21 percent versus 21 percent; p = 1.00). There were no significant differences between the groups in complication rates for hematomas, seromas, impaired wound healing, and infection. Although prepectoral placement was associated with prolonged time to drain removal, those patients completed the expansion process twice as fast, were expanded further in the operating room, and were more than twice as likely to forgo clinic-based expansion. Prepectoral reconstruction was not associated with increased risk for any complications in univariate or multivariable analysis.

Conclusions:

Prepectoral tissue expander placement permitted greater intraoperative filling of expanders and a reduced likelihood of clinic-based expansion, with no increase in adverse outcomes compared to partial subpectoral placement. Adoption of this technique may reduce unnecessary clinic visits; shorten the delay before adjuvant therapy; and minimize patient apprehension, pain, and discomfort related to clinic-based expansion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Oncologic Safety of Autologous Fat Grafting after Breast Cancer Surgical Treatment: A Matched Cohort Study
Authors: Tukiama Ricardo , Vieira René A. C. , Facina Gil , da Cunha Leal Plínio , Zucca-Matthes Gustavo
Published: May 2021

Background:

Autologous fat grafting has been an increasingly popular procedure for remodeling the breast of patients undergoing breast cancer surgery. This study’s objective was to investigate whether autologous fat grafting is associated with a higher risk of disease recurrence in the context of late breast reconstruction for patients diagnosed with breast cancer who have undergone either breast-conserving surgery or mastectomy.

Methods:

A retrospective matched cohort study was performed in a single tertiary health care center. Data were collected from 42 patients formerly treated for breast cancer who underwent the first session of autologous fat grafting between August of 2007 and June of 2016. A total of 126 patients with similar features, who did not undergo autologous fat grafting, were individually matched at a 1:3 ratio with the autologous fat grafting group. The primary endpoint was locoregional recurrence. Secondary outcomes were rates of local and distant recurrences, disease-free survival, and overall survival.

Results:

At a mean follow-up of 65 months after fat grafting, no significant differences were found between the lipofilling and control groups for locoregional recurrence (7.1 percent versus 6.3 percent; p = 0.856), local recurrence (7.1 percent versus 5.6 percent; p = 0.705), distant recurrence (14.3 percent versus 7.9 percent; p = 0.238), disease-free survival (21.4 percent versus 19.0 percent; p = 0.837), and overall survival (14.3 percent versus 7.1 percent; p = 0.181).

Conclusions:

No evidence of increased risk in any of the survival outcomes was identified. Lipofilling seems to be a safe procedure for breast reconstruction after surgical treatment of breast cancer.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Topographic Anatomy of the Zygomatico-Orbital Artery: Implications for Improving the Safety of Temporal Augmentation
Authors: Liu Shuo , Yan WeiJie , Wang GuiMing , Zhao Rui , Qiu He , Cao LiDeng , Wang Hang
Published: May 2021

Background:

Anatomical knowledge of the zygomatico-orbital artery and its most relevant clinical applications is essential for ensuring the safety of filler injection into the temporal region. The purpose of this study was to provide the precise position, detailed course, and relationship with surrounding structures of the zygomatico-orbital artery.

Methods:

Fifty-eight patients who underwent head contrast-enhanced three-dimensional computed tomography and 10 fresh frozen cadavers were investigated.

Results:

The zygomatico-orbital artery was identified in 93 percent of the samples in this work. Ninety-four percent of the zygomatico-orbital arteries derived directly from the superficial temporal artery, and the remaining arteries started from the frontal branch of the superficial temporal artery. According to the origin of the zygomatico-orbital artery, it was classified into type I and type II. Type I arteries were then classified into three subtypes. The trunk of the zygomatico-orbital artery was located between the deep temporal fascia and the superficial temporal fascia. Deep branches of the zygomatico-orbital artery pierced the superficial layer of the deep temporal fascia. The zygomatico-orbital artery originated from 11.3 mm in front of the midpoint of the apex of the tragus, and most of its trunks were located less than 20.0 mm above the zygomatic arch. The mean diameter of the zygomatico-orbital artery was 1.2 ± 0.2 mm. There were extensive anastomoses between the zygomatico-orbital artery and various periorbital arteries at the lateral orbital rim.

Conclusion:

The precise anatomical knowledge of the zygomatico-orbital artery described in this study could be helpful for cosmetic physicians for improving the safety of temporal augmentation.
Variation of anti-A and anti-B titers in group O potential blood donors: A pilot study
Authors: Koch Eric J. , Snow Ryan , Cook Jeffrey T. , Wickman Danielle , Lee Joseph , Zarow Gregory J.
Published: May 2021

BACKGROUND

Resuscitation with fresh whole blood is vital to preserving life on the battlefield. Transfusing low titer O whole blood (LTOWB), defined as anti-A and anti-B titer levels of <1:256, is safe because LTOWB alleviates the risk for hemolytic transfusion reactions. Because of possible variations in titer levels over time, a study was needed using US Navy and Marine Corps personnel to assess how these titers change across two assessments.

METHODS

Retrospective data from group O marines and sailors (M = 25 years of age; range, 19–35 years) stationed in the San Diego region were acquired from the Armed Services Blood Program and the Composite Health Care System. Of 972 group O donors between January 2016 and November 2019, 55 donors with 2 samples were identified (N = 55). Analysis included contrasting rates of high (≥1:256) and low (<1:256) anti-A and anti-B titers on the initial and second blood tests, along with the time between testings.

RESULTS

The average time between testing was 332 days (range, 35–1,121 days), which far exceeded the recommended 90-day interval (p < 0.00001). Only 45% met the 90-day recommendation. Titer status changed frequently, from low to high (anti-A, 18%; anti-B, 13%; LTOWB to not LTOWB, 21%) or from high to low (anti-A, 62%; anti-B, 78%; not LTOWB to LTOWB, 62%).

CONCLUSIONS

Anti-A and anti-B titers change frequently enough to warrant testing immediately before deployment and even during deployment. The observed time elapsed between testing is unacceptably long. The present pilot study provides a foundation for a larger formal study to more fully characterize titer changes over repeated testing.

LEVEL OF EVIDENCE

Diagnostic test, level IV
Contained Rupture of a Posterior Communicating Artery Aneurysm in a Patient With a Third Nerve Palsy
Authors: Dhoot Arjan S. , Guest William C. , Bharatha Aditya , Micieli Jonathan A.
Published: May 2021

It is recommended that every patient with a new third nerve palsy undergo urgent neuroimaging (computed tomography angiography or magnetic resonance angiography) to exclude a posterior communicating artery aneurysm. Because of the novel coronavirus (COVID-19) pandemic, our institution noted a significant decline in the number of patients with aneurysmal subarachnoid hemorrhage presenting to the hospital. We report one such example of a patient who developed new-onset severe headache and vomiting and did not seek medical attention because of COVID-19. Two months later, she was noted to have ptosis during a routine follow-up and was found to have a complete, pupil-involving third nerve palsy. Computed tomography angiography was performed and revealed an irregular bilobed saccular aneurysm (7 × 9 × 5 mm) of the right posterior communicating (PComm) artery, but no acute hemorrhage was visible on CT. On MRI, immediately adjacent to the aneurysm, there was a small subacute hematoma in the right medial temporal lobe with surrounding vasogenic edema. This case had a fortunate and unique outcome as she had a contained hematoma adjacent to the ruptured PComm aneurysm and did not experience severe morbidity from the subarachnoid hemorrhage nor did she rebleed in the interval in which she did not seek care. This case highlights the importance of providing neuro-ophthalmic care even during a pandemic.
Cavernous Malformation of the Optic Nerve and Chiasm: Prompt Suspicion and Surgery Matter
Authors: Kostic Maja , Subramanian Prem S. , Falcone Steven F. , El-Swaify Seif Tarek , Sur Samir , Spasic Smiljana , Miller Neil R. , Morcos Jacques J. , Lam Byron L.
Published: May 2021

Background:

Cavernous malformations (CMs) of the optic nerve and chiasm are extremely rare, accounting for less than 1% of all intracranial CMs. Acute, subacute, or progressive visual loss from CM may occur with or without hemorrhage. Prompt surgical excision of the CM offers the best hope to improve or stabilize vision. Given its rarity, optic nerve and chiasm CMs may not be readily suspected. We provide 3 cases of optic nerve and chiasm CM, highlighting key neuroimaging features and the importance of expedited intervention.

Methods:

Case records of the neuro-ophthalmology clinics of the Bascom Palmer Eye Institute and the University of Colorado, and literature review of reported cases of optic CM.

Results:

A 49-year-old woman reported acute progressive painless vision loss in the right eye. MRI showed a suprasellar mass with heterogeneity in signal involving the right prechiasmatic optic nerve. Surgical excision of the CM 5 days after onset of visual loss improved vision from 20/300 to 20/30. A 29-year-old woman with acute painless blurred vision in the right eye had anterior chiasmal junctional visual field defects corresponding to a heterogeneously minimally enhancing mass with blood products enlarging the optic chiasm and proximal right optic nerve. Surgical excision of the CM 8 weeks after onset of visual loss improved vision from 20/40 to 20/15 with improved visual fields. A 33-year-old woman with a history of familial multiple CMs, diagnosed at age 18, reported new-onset severe headache followed by blurred vision. MRI showed a hemorrhagic lesion of the optic chiasm and right optic tract. She was 20/20 in each eye with a reported left superior homonymous hemianopia. No intervention was recommended. Vision of the right eye worsened to 20/400 2 months later. The patient was followed over 13 years, and the MRI and visual function remained unchanged. Literature review yielded 87 optic CM cases occurring across gender and nearly all ages with visual loss and headache as the most common presenting symptoms. Optic chiasm is the most common site of involvement (79%). Nearly 95% of reported CM cases were treated with surgery with 81% with improved vision and 1% with worsened vision.

Conclusion:

MRI features are critical to the diagnosis of optic nerve and chiasm CM and may mimic other lesions. A high index of suspicion by the neuro-ophthalmologist and neuroradiologist leads to early recognition and intervention. Given optic CM displaces and does not infiltrate neural tissue, expedited surgical resection by a neurosurgeon after consideration of other diagnostic possibilities improves visual function in most cases.
The effects of substance use on severe acute respiratory syndrome coronavirus infection risks and outcomes
Authors: Balaram Kripa , Marwaha Raman , Kaelber David C.
Published: May 2021

Purpose of review

Severe acute respiratory syndrome coronavirus (SARS-CoV2) infection rates are currently occurring at alarmingly accelerated rates. There is also a long-standing and concurrent rise in the prevalence and severity of substance use disorders (SUD). Therefore, the intersection between these two conditions needs to be carefully considered to ensure a more effective delivery of healthcare.

Recent findings

Generally, those with SUDs are more likely to have higher risk social determinants of health factors. Therefore, these patients are more likely to have barriers that can create difficulties in following appropriate infection control measures which in turn increases the risk of exposure to SARS-CoV2. In addition, these individuals have higher rates of medical comorbidities which increases the risk of all adverse outcomes, including mortality, from SARS-CoV2 infection.

Individuals with SUDs are at increased risk of both contracting SARS-CoV2 infection and suffering from worse outcomes afterwards. Though these risks of adverse outcomes are specific of SARS-CoV2 infection, the risk of exposure to other infectious diseases is increased in this population too. Healthcare providers and policymakers should then consider how to better protect this at-risk population and alleviate this increased disease burden.
Performance evaluation of the BD SARS-CoV-2 reagents for the BD MAX™ system
Authors: Yanson Karen , Laviers William , Neely Lori , Lockamy Elizabeth , Castillo-Hernandez Luis Carlos , Oldfied Christopher , Ackerman Ronald , Ackerman Jamie , Ortiz Daniel A , Pacheco Sixto , Simner Patricia J , Young Stephen , McElvania Erin , Cooper Charles K
Published: May 2021

Background

The RT-qPCR assay for detecting SARS-CoV-2 virus is the favorable approach to test suspected COVID-19 cases. However, discordant results can occur when two or more assays are compared. Variability in analytical sensitivities between assays, among other factors, may account for these differences in reporting.

Methods

The limits of detection (LOD) for the BD SARS-CoV-2 Reagents for BD MAX™ System (“MAX SARS-CoV-2 assay”), the Biomerieux BioFire® Respiratory Panel 2.1 (“BioFire SARS-CoV-2 assay”), the Roche cobas SARS-CoV-2 assay (“cobas SARS-CoV-2 assay”), and the Hologic Aptima® SARS-CoV-2 assay Panther® (“Aptima SARS-CoV-2 assay”) RT-qPCR systems were determined using a total of 84 contrived nasopharyngeal specimens with seven target levels for each comparator. The positive and negative percent agreement (PPA and NPA, respectively) for the MAX SARS-CoV-2 assay were compared to the Aptima SARS-CoV-2 assay in a post-market clinical study utilizing 708 paired nasopharyngeal specimens collected from suspected COVID-19 cases. Discordant results were further tested by the cobas and BioFire SARS-CoV-2 assays.

Results

The measured LOD for the MAX SARS-CoV-2 assay (251 copies/mL) was comparable to the cobas SARS-CoV-2 assay (298 copies/mL) and the BioFire SARS-CoV-2 assay (302 copies/mL); the Aptima SARS-CoV-2 assay had a LOD of 612 copies/mL. The MAX SARS-CoV-2 assay had a PPA of 100% (95%CI: [97.3%-100.0%]) and a NPA of 96.7% (95%CI: [94.9%-97.9%]) when compared to the Aptima SARS-CoV-2 assay.

Conclusions

The MAX SARS-CoV-2 assay exhibited a high analytical sensitivity and specificity for SARS-CoV-2 detection. The clinical performance of the MAX SARS-CoV-2 assay agreed with another sensitive EUA cleared assay.
SPARSEMODr: Rapid simulations of spatially explicit and stochastic models infectious diseases, including COVID-19
Authors: Mihaljevic Joseph R , Borkovec Seth , Ratnavale Saikanth , Hocking Toby D , Banister Kelsey E , Eppinger Joseph E , Hepp Crystal , Doerry Eck
Published: May 2021

Building realistically complex models of infectious disease transmission that are relevant for informing public health is conceptually challenging and requires knowledge of coding architecture that can implement key modeling conventions. For example, many of the models built to understand COVID-19 dynamics have included stochasticity, transmission dynamics that change throughout the epidemic due to changes in host behavior or public health interventions, and spatial structures that account for important spatio-temporal heterogeneities. Here we introduce an R package, SPARSEMODr, that allows users to simulate disease models that are stochastic and spatially explicit, including a model for COVID-19 that was useful in the early phases of the epidemic. SPARSEMOD stands for SPAtial Resolution-SEnsitive Models of Outbreak Dynamics, and our goal is to demonstrate particular conventions for rapidly simulating the dynamics of more complex, spatial models of infectious disease. In this report, we outline the features and workflows of our software package that allow for user-customized simulations. We believe the example models provided in our package will be useful in educational settings, as the coding conventions are adaptable, and will help new modelers to better understand important assumptions that were built into sophisticated COVID-19 models.
Model-M: An agent-based epidemic model of a middle-sized municipality
Authors: Berec Luděk , Diviák Tomáš , Kuběna Aleš , Levínský René , Neruda Roman , Suchopárová Gabriela , Šlerka Josef , Šmíd Martin , Trnka Jan , Tuček Vít , Vidnerová Petra , Zajíček Milan , Zapletal František
Published: May 2021

This report presents a technical description of our agent-based epidemic model of a particular middle-sized municipality. We have developed a realistic model with 56 thousand inhabitants and 2.7 millions of social contacts. These form a multi-layer social network that serves as a base of our epidemic simulation. The disease is modeled by our extended SEIR model with parameters fitted to real epidemics data for Czech Republic. The model is able to simulate a whole range of non-pharmaceutical interventions on individual level, such as protective measures and physical distancing, testing, contact tracing, isolation and quarantine. The effect of government-issued measures such as contact restrictions in different environments (schools, restaurants, vendors, etc.) can also be simulated.

The model is implemented in Python and is available as open source at:www.github.com/epicity-cz/model-m/releases
Non-differential risk of SARS-CoV-2 infection for members of polling stations on Catalan parliament voting day
Authors: Medina-Peralta Manuel , Garcia-Eroles Luis , Hermosilla Eduardo , Fuentes Antonio , Méndez-Boo Leonardo , Fina Francesc , Fàbregas Mireia , Coma Ermengol , Lejardi Yolanda , Ramentol Marc , Peña-López Ismael
Published: May 2021

We aimed to assess the risk of SARS-CoV-2 infection for polling station members during the Catalan elections in February 2021. We compared the incidence 14 days after the elections between a cohort of polling station members (N= 18,304) and a control cohort paired by age, sex and place of residence. A total of 37 COVID-19 cases (0.2%) were confirmed in the members of the polling stations and 43 (0.23%) in the control group (p-value 0.576). Our study suggests that there was no greater risk of infection for the members of the polling stations.
Sensitive detection of Plasmodium vivax malaria by the rotating-crystal magneto-optical method in Thailand
Authors: Orbán Ágnes , Longley Rhea J. , Sripoorote Piyarat , Maneechai Nongnuj , Nguitragool Wang , Butykai Adam , Mueller Ivo , Sattabongkot Jetsumon , Karl Stephan , Kézsmárki István
Published: May 2021

The rotating-crystal magneto-optical detection (RMOD) method has been developed for the rapid and quantitative diagnosis of malaria and tested systematically on various malaria infection models. Very recently, an extended field trial in a high-transmission region of Papua New Guinea demonstrated its great potential for detecting malaria infections, in particular Plasmodium vivax. In the present small-scale field test, carried out in a low-transmission area of Thailand, RMOD confirmed malaria in all samples found to be infected with Plasmodium vivax by microscopy, our reference method. Moreover, the magneto-optical signal for this sample set was typically 1–3 orders of magnitude higher than the cut-off value of RMOD determined on uninfected samples. Based on the serial dilution of the original patient samples, we expect that the method can detect Plasmodium vivax malaria in blood samples with parasite densities as low as ∼ 5 − 10 parasites per microliter, a limit around the pyrogenic threshold of the infection. In addition, by investigating the correlation between the magnitude of the magneto-optical signal, the parasite density and the erythrocytic stage distribution, we estimate the relative hemozoin production rates of the ring and the trophozoite stages of in vivo Plasmodium vivax infections.
Pregnancy-induced changes in blood composition drive post-partum hemorrhage risk
Authors: Robinson Matthew R. , Patxot Marion , Stojanov Miloš , Blum Sabine , Baud David
Published: May 2021

The extent to which women differ in the course of blood cell counts throughout pregnancy, and the importance of these changes to pregnancy outcomes has not been well defined. Here, we develop a series of statistical analyses of repeated measures data to reveal the degree to which women differ in the course of pregnancy, predict the changes that occur, and determine the importance of these changes for post-partum hemorrhage which is one of the leading causes of maternal mortality. We present a prospective cohort of 4,082 births recorded at the University Hospital, Lausanne, Switzerland between 2009 and 2014 where full labour records could be obtained, along with complete blood count data taken at hospital admission. We find significant differences, at a p < 0.001 level, among women in how blood count values change through pregnancy for mean corpuscular hemoglobin, mean corpuscular volume, mean platelet volume, platelet count and red cell distribution width. We find evidence that almost all complete blood count values show trimester-specific associations with postpartum hemorrhage and that tracking blood count value changes through pregnancy improves identification of women at increased risk, with increased area under the receiver operator curve in independent patient samples. Differences among women in the course of blood cell counts throughout pregnancy have an important role in shaping pregnancy outcome. Modelling trimester-specific associations with pregnancy outcomes, in a way that fully utilizes repeated measures data, provides greater understanding of the complex changes in blood count values that occur through pregnancy and provides indicators to guide the stratification of patients into risk groups.
Prediction of the effective reproduction number of COVID-19 in Greece. A machine learning approach using Google mobility data
Authors: Athanasios Arvanitis , Irini Furxhi , Tasioulis Thomas , Konstantinos Karatzas
Published: May 2021

This paper demonstrates how a short-term prediction of the effective reproduction number (Rt) of COVID-19 in regions of Greece is achieved based on online mobility data. Various machine learning methods are applied to predict Rt and attribute importance analysis is performed to reveal the most important variables that affect the accurate prediction of Rt. Our results are based on an ensemble of diverse Rt methodologies to provide non-precautious and non-indulgent predictions. The model demonstrates robust results and the methodology overall represents a promising approach towards COVID-19 outbreak prediction. This paper can help health related authorities when deciding non-nosocomial interventions to prevent the spread of COVID-19.
Functional Brain Networks in Focal Dystonia and their Associations with Dystonic Behavior
Authors: Bukhari-Parlakturk Noreen , Fei Michael , Voyvodic James , Davis Simon , Michael Andrew
Published: May 2021

Multiple neuroimaging studies suggest that dystonia is a network-level brain disorder, but the key networks to target for brain therapy in dystonia remain poorly understood. This study identified impaired functional networks (FNs) in writer’s cramp (WC) dystonia while participants performed hand motor tasks in the scanner. Task-fMRI images were acquired from twelve WC and twelve healthy volunteers (HV) while they performed writing, tapping, and flexion-extension motor tasks. Group independent component analysis was used to derive FNs, and functional network connectivity (FNC) between the FNs was computed to evaluate their associations with dystonic behavior. Our approach revealed three novel findings: First, we found that the basal ganglia, orbitofrontal, and superior parietal FNs were aberrant during the on-block of the task and, interestingly, also during the off-block period reminiscent of the loss of network inhibitory response during writing in WC. Second, we found multiple impaired FNC patterns in WC primarily in these three FNs these results were further validated through non-parametric testing via Monte Carlo simulations. Third, using FNC deficits and FNC-writing legibility correlations, we characterized these FNC patterns as primary or secondary associations with the motor program for writing. Findings from our data-driven whole-brain analysis approach reveal new FNs disrupted in dystonia and they may serve as key targets for the treatment of this disorder.

Impact Statement

Dystonia is a rare and disabling brain disorder affecting motor function. In this study, novel functional network differences in dystonia were identified. Associations between functional network connectivity and dystonic behavior were found. Through a data-driven approach, this study reveals new targets for dystonia treatment.
CAR-T cells Targeting Thyroid-stimulating Hormone Receptor (TSHR) Demonstrate Safety and Potent Preclinical Activity Against Differentiated Thyroid Cancer
Authors: Li Hanning , Zhou Xiang , Wang Ge , Hua Dongyu , Li Shuyu , Xu Tao , Dong Menglu , Cui Xiaoqing , Yang Xue , Wu Yonglin , Cai Miaomiao , Liao Xinghua , Zhang Tongcun , Yang Zhifang , Du Yaying , Li Xingrui
Published: May 2021

Background

Differentiated thyroid cancer (DTC) is usually very treatable and is often cured with surgery and, if indicated, follow with radioactive iodine (RAI) and long-term thyroid-stimulating hormone (TSH) suppression with levothyroxine. Unfortunately, locoregional relapse and distant metastases occur in up to 20% at ten years; those relapsed or distant metastatic thyroid cancer is relatively uncommon compare to other cancers, cytotoxic chemotherapies provided low response rates, and two-thirds of cases became RAI refractory (RAI-R). New therapy options for local-regional relapsed or distant metastases thyroid cancer are desperately needed. Chimeric antigen receptor T cells (CAR-T) have been demonstrated remarkable efficacy in hematological cancers but have not yet translated in treating solid tumors. The significant hurdles limiting CAR-T therapy were due to a paucity of differentially expressed cell surface molecules on solid tumors that can be safely targeted. Here, we present thyroid-stimulating hormone receptor (TSHR) as a putative target for CAR-T therapy of DTC.

Methods

We undertook a large-scale screen on thyroid cancer tissues and multiple internal organs through bioinformatical analysis and immunohistochemistry to date TSHR expression. Using three previously described mAb, we generate three third-generation CAR-Ts. We tested anti-TSHR CAR-T in vitro activity by T-cell function assay and killing assay. Then we tested pre-clinical therapeutical efficacy in a xenograft mouse model of DTC and analyzed mice’s physical conditions and histological abnormalities to evaluate anti-TSHR CAR-T’s safety.

Results

TSHR is highly and homogeneously expressed on 90.8%(138/152) of papillary thyroid cancer, 89.2% (33/37) of follicular thyroid cancer, 78.2% (18/23) of the cervical lymph node metastases, and 86.7% of locally recurrent or metastasis lesions with RAI-R disease. We develop three novel anti-TSHR CAR-T from mAb M22, K1-18, and K1-70, all three CAR-Ts mediate significant anti-tumor activity in vitro. Among these, we demonstrate that K1-70 CAR-T can have therapeutical efficacy in vivo, and no apparent toxicity has been observed.

Conclusion

TSHR is a latent target antigen of CAR-T therapy for DTC. Anti-TSHR CAR-T has strong therapeutical efficacy in vivo while without prominent adverse events. Anti-TSHR CAR-T could represent an exciting therapeutic option for patients with specific local-regional relapsed or distant metastases thyroid cancer and should be tested in carefully designed clinical trials.
Co-establishing an infrastructure for routine data collection to address disparities in infant mortality: Planning and implementation
Authors: Fareed Naleef , Swoboda Christine , Griesenbrock Tyler , Lawrence John , Huerta Timothy R.
Published: May 2021

Background

Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations.

Methods

Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings.

Results

By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis.

Conclusion

While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone.