bluuebunny/crossref_metadata_2025 huggingface dataset:
769 Racial, Ethnic, and Socioeconomic Disparities in Burn Care Access
Authors: Tomtschik Julia , Sweitzer Keith , Cook Caitlin , O'Shea Aidan , Bell Derek
Published: May 2023

Introduction

While racial, ethnic, and socioeconomic disparities in burn care have been identified, there is a paucity of research into specific means by which these disparities manifest. Here, we consider time to initial burn surgery consult.

Methods

Through a retrospective review of electronic health records, we reviewed all patients evaluated by the burn surgery service at a single regional burn center from Jun 2020 to Apr 2022. We excluded patients without data for time of onset of burn injury. We analyzed differences in time to burn consult, rate of surgical management, and average length of stay (LOS), stratifying by patient race (Caucasian, Black, Asian, Native American, Other), ethnicity (Latino, non-Latino, Other), and insurance payor (Medicaid, Private, Medicare, Other, None). Time to burn consult was defined as time from onset of burn injury to time of burn consult.

Results

365 patients met the inclusion criteria. Average age was 33.3 years; 65.8% were male. Average (standard deviation) time to burn consult was 17h7m (1d23h21m). No significant differences in time to burn consult existed when the study group was stratified by race, ethnicity, or insurance payor. Rate of surgical management (Chi-squared p=0.05) and LOS (ANOVA p< 0.0001) differed by insurance payor, but not race or ethnicity. Medicare patients had higher rates of surgical intervention and longer average LOS; patients with no insurance had lower rates of surgical intervention and shorter average LOS.

Conclusions

Our results indicate that time to burn consult is unlikely to contribute meaningfully to racial, ethnic, and socioeconomic disparities in burn care. Further studies are needed to better understand other aspects of care that may contribute to these disparities.

Applicability of Research to Practice

Time to burn consult is unlikely to contribute to disparities in burn care. Burn care providers should be mindful of other ways that disparities may manifest.
770 Outcome Results of the Prospective CEA Registry
Authors: Homsombath Bounthavy , Sood Rajiv , Hartman Brett , Fagan Shawn , Griswold John
Published: May 2023

Introduction

Cultured epidermal autograft (CEA) is a permanent skin replacement indicated for use in adult and pediatric patients with deep dermal or full thickness burns comprising a total body surface area (TBSA) ≥ 30%. CEA may be used in conjunction with split-thickness autografts or alone, in patients for whom split-thickness autografts may not be an option due to the severity and extent of their burns. CEA was approved for use in adults in the United States in 2007 as a Humanitarian Use Device (HUD) under a Humanitarian Device Exemption (HDE) and was approved for pediatric use in 2016.

Methods

The objective of the CEA Registry is to allow prospective collection and analysis of demographic, treatment, and outcome data for the real-world use of CEA. Prior to initiation of the Registry, a central Institutional Review Board reviewed and approved written procedures and informed consent from each participating burn center. As of the date of this analysis, 5 centers were enrolling patients in the Registry. The data are collected and stored in a 21 Code of Federal Regulations (CFR) Part 11 and Health Insurance Portability and Accountability Act (HIPAA) compliant environment. First patient enrollment in the Registry was 13 June 2019 and data cutoff for this analysis was 28 July 2022.

Results

Sixtyeight patients (50 adults and 18 children) had completed data in the registry, up through hospital discharge, for this analysis. Except for age and revised Baux score, demographics and burn characteristics were similar between the adult and pediatric populations. The majority of patients were male in both the adult (76%) and pediatric (67%) groups, with burn caused by flame the most common etiology (86% and 78%, respectively). The total body surface area (TBSA) of burn was 58% in adults and 56% in pediatric patients (range 30% to 96%), and almost half had inhalation injury in each group. Approximately 74% of adults and 67% of pediatric patients had TBSA ≥50%. Median age in the adult group was 42 years, and in the pediatric group was 15 years. Since age is a component of the calculation of Baux score, pediatric patients had lower mean revised Baux scores (75) compared to adults (107.5). Overall, 59 of the 68 patients (87%) survived until hospital discharge. The mean % graft take (engraftment) in both adult (81%) and pediatric (84%) groups is notable when compared to mean final graft take in 453 Epiceltreated patients reported in the HDE database (67% in adults and 70% in pediatric). By age group, adults had 84% survival rate and pediatric patients had 94% survival.

Conclusions

Outcomes from this prospective collection of data in severely burned patients treated with CEA demonstrate favorable engraftment and survival rates and are in general agreement with recent literature.

Applicability of Research to Practice

Reported outcomes from the CEA Registry can be used as a benchmark by centers using CEA for treatment of burns.
775 Increased Reimbursement by Decreasing the Mortality Index Using GLIM in the Elderly for Malnutrition
Authors: Hollowell Jamie , Cruz Aryn , Marsh Molly , King Booker , Williams Felicia , Maxwell Eli
Published: May 2023

Introduction

One of the primary factors for burn wound healing is adequate nutrition. Many burn patients require supplemental nutrition during their burn care, however, their pre-existing nutritional status is also a factor in their morbidity and mortality. Malnutrition on admission or during their hospital stay has a significant impact on outcomes including wound healing, infection, and length of stay, along with effects on reimbursement and mortality outcomes predictors. American Society for Parenteral and Enteral Nutrition (ASPEN) criteria have long been used to assess malnutrition in burn patients in our institution though this may not be the ideal assessment tool, especially in patients over 65 years of age. In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) working group created an updated assessment for malnutrition that takes additional factors into account. We aimed to compare ASPEN to GLIM criteria to determine if there is a difference in the number of patients meeting the criteria for malnutrition in the elderly.

Methods

All patients admitted between July 2013 to June 2021, 65 years or older, burn or skin disorder of at least 20% total body surface area, designated as Normal or underweight based upon body mass index, with registered dietitian assessments and lengths of stay of at least 2 days were included. Patients were identified using the Institutional Burn Center registry, and linked to the clinical and administrative data. Primary outcome was whether or not those patients triggered malnutrition diagnosis based upon ASPEN or GLIM criteria.

Results

Three hundred sixty-five patients were included in the study. Twenty-five patients had burns over 20%, and 14 met the criteria for nutritional assessment. Using ASPEN criteria, 2 out of 14 patients met criteria for malnutrition. Of those same patients, 8 out of 14 patients met criteria for malnutrition using GLIM assessment.

Conclusions

While this study is not powered for statistical analysis, the results demonstrate that GLIM may be a valuable adjunct to ASPEN to assess malnutrition in burn patients, especially in those patients over 65 years of age. Further study is needed to examine whether GLIM would be a superior tool or at least a worthy addition to our nutritional analysis. Burn patients have a unique need for adequate nutrition to support healing, and accurate evaluation of their requirements warrants a precise tool.

Applicability of Research to Practice

This study may demonstrate the need for additional evaluation of GLIM as a replacement or adjunct tool for malnutrition in the burn population. This study may also suggest the need for further assessment of other tools to evaluate nutrition on in this population. This study may also suggest impact on mortality index and length of stay that affect reimbursement and rankings.
Triage and Evaluation of Blast-Injured Patients in Wenling Liquefied Petroleum Gas Tanker Explosion
Authors: Shao Jiaming , Zhu Zhikang , Xu Bin , Wang Shuangshuang , Jin Ronghua , Yang Min , Zhang Wei , Han Chunmao , Wang Xingang
Published: May 2023

On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, the authors describe the mass casualty emergency response to the explosion. The authors collected the medical records of 176 inpatients at 8 hospitals in Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to six hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital for postsecondary triage. Forty-four patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of whom 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. Sixteen burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the eight patients who died in the prehospital session, seven had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.
Ten-year update: NRG Oncology/National Surgical Adjuvant Breast and Bowel Project B-42 randomized trial: extended letrozole therapy in early-stage breast cancer
Authors: Mamounas Eleftherios P , Bandos Hanna , Rastogi Priya , Lembersky Barry C , Jeong Jong-Hyeon , Geyer Charles E , Fehrenbacher Louis , Chia Stephen K , Brufsky Adam M , Walshe Janice M , Soori Gamini S , Dakhil Shaker R , Wade James L , McCarron Edward C , Swain Sandra M , Wolmark Norman
Published: May 2023

Background

The National Surgical Adjuvant Breast and Bowel Project B-42 trial evaluated extended letrozole therapy (ELT) in postmenopausal breast cancer patients who were disease free after 5 years of aromatase inhibitor (AI)–based therapy. Seven-year results demonstrated a nonstatistically significant trend in disease-free survival (DFS) in favor of ELT. We present 10-year outcome results.

Methods

In this double-blind, phase III trial, patients with stage I-IIIA hormone receptor–positive breast cancer, disease free after 5 years of an AI or tamoxifen followed by an AI, were randomly assigned to 5 years of letrozole or placebo. Primary endpoint was DFS, defined as time from random assignment to breast cancer recurrence, second primary malignancy, or death. All statistical tests are 2-sided.

Results

Between September 2006 and January 2010, 3966 patients were randomly assigned (letrozole: 1983; placebo: 1983). Median follow-up time for 3923 patients included in efficacy analyses was 10.3 years. There was statistically significant improvement in DFS in favor of letrozole compared with placebo (hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.74 to 0.96; P  = .01; 10-year DFS: placebo = 72.6%, letrozole = 75.9%, absolute difference = 3.3%). There was no difference in the effect of letrozole on overall survival (HR = 0.97, 95% CI = 0.82 to 1.15; P  = .74). Letrozole statistically significantly reduced breast cancer–free interval events (HR = 0.75, 95% CI = 0.62 to 0.91; P = .003; absolute difference in cumulative incidence = 2.7%) and distant recurrences (HR = 0.72, 95% CI = 0.55 to 0.92; P = .01; absolute difference = 1.8%). The rates of osteoporotic fractures and arterial thrombotic events did not differ between treatment groups.

Conclusions

The beneficial effect of ELT on DFS persisted at 10 years. Letrozole also improved breast cancer–free interval and distant recurrences without improving overall survival. Careful assessment of potential risks and benefits is necessary for selecting appropriate candidates for ELT.
Introduction to the suite: The Child as Reader, Philosopher, and Social Critic: Evaluating the Vision of Gareth B. Matthews
Authors: Gregory Maughn Rollins , Laverty Megan Jane
Published: May 2023

Gareth B. Matthews (1929–2011) was a specialist in ancient and medieval philosophy whose conversations with young children led him to discover their penchant for philosophical thinking, which often enriched his own. Those conversations became the impetus for a substantial component of Matthews’ scholarship, from which our book, Gareth B. Matthews, The Child’s Philosopher, features essays spanning the length of his career. Contemporary contributors to the book critically evaluate Matthews’ scholarship in three fields he helped to initiate: philosophy in children’s literature, philosophy for children, and philosophy of childhood. They assess where he broke new ground and identify developments and debates in those fields. In the reviews that follow, Harry Brighouse, David Bakhurst, and Sheron Fraser-Burgess respond to Matthews’ original essays and those of the contemporary scholars. While recognizing Matthews’ significant contribution to advancing philosophy in the lives of children, all three reviewers indicate ways to push his agenda forward. We read Brighouse as calling for engagement with philosophy in media (including television and film) beyond classical and contemporary children’s literature. Bakhurst explicitly calls for further empirical study of children’s philosophical thinking to support more realistic conceptions of childhood and philosophy—including when philosophy might not be appropriate for children. Fraser-Burgess calls for an accounting of the ways that philosophy for children may reinscribe unjust hierarchies of race, gender, and culture, and of the ways it can be used to confront and combat them.
A model where the least trimmed squares estimator is maximum likelihood
Authors: Berenguer-Rico Vanessa , Johansen Søren , Nielsen Bent
Published: May 2023

The least trimmed squares (LTS) estimator is a popular robust regression estimator. It finds a subsample of h ‘good’ observations among n observations and applies least squares on that subsample. We formulate a model in which this estimator is maximum likelihood. The model has ‘outliers’ of a new type, where the outlying observations are drawn from a distribution with values outside the realized range of h ‘good’, normal observations. The LTS estimator is found to be h1/2 consistent and asymptotically standard normal in the location-scale case. Consistent estimation of h is discussed. The model differs from the commonly used ϵ-contamination models and opens the door for statistical discussion on contamination schemes, new methodological developments on tests for contamination as well as inferences based on the estimated good data.
A Selective Bottleneck During Host Entry Drives the Evolution of New Legume Symbionts
Authors: Doin de Moura Ginaini Grazielli , Mouffok Saida , Gaudu Nil , Cazalé Anne-Claire , Milhes Marine , Bulach Tabatha , Valière Sophie , Roche David , Ferdy Jean-Baptiste , Masson-Boivin Catherine , Capela Delphine , Remigi Philippe
Published: May 2023

During the emergence of new host–microbe symbioses, microbial fitness results from the ability to complete the different steps of symbiotic life cycles, where each step imposes specific selective pressures. However, the relative contribution of these different selective pressures to the adaptive trajectories of microbial symbionts is still poorly known. Here, we characterized the dynamics of phenotypic adaptation to a simplified symbiotic life cycle during the experimental evolution of a plant pathogenic bacterium into a legume symbiont. We observed that fast adaptation was predominantly explained by improved competitiveness for host entry, which outweighed adaptation to within-host proliferation. Whole-population sequencing of bacteria at regular time intervals along this evolution experiment revealed the continuous accumulation of new mutations (fuelled by a transient hypermutagenesis phase occurring at each cycle before host entry, a phenomenon described in previous work) and sequential sweeps of cohorts of mutations with similar temporal trajectories. The identification of adaptive mutations within the fixed mutational cohorts showed that several adaptive mutations can co-occur in the same cohort. Moreover, all adaptive mutations improved competitiveness for host entry, while only a subset of those also improved within-host proliferation. Computer simulations predict that this effect emerges from the presence of a strong selective bottleneck at host entry occurring before within-host proliferation and just after the hypermutagenesis phase in the rhizosphere. Together, these results show how selective bottlenecks can alter the relative influence of selective pressures acting during bacterial adaptation to multistep infection processes.
Factors determining family and social support among pulmonary tuberculosis patients in East Khasi Hills, Meghalaya: a cross-sectional study
Authors: Nadon Herman , Dmello Mackwin K , Shetty Shraddha
Published: May 2023

Introduction

Family support plays a vital role in the outcome of individuals with tuberculosis (TB).

Objectives

To determine the family and social support among individuals with pulmonary TB during treatment.

Methods

A cross-sectional survey was conducted among 237 pulmonary TB patients currently in the continuous phase of treatment. Bivariate and multivariate analyses were conducted to determine the association and predictors for family and social support. P-value < 0.05 was considered statistically significant.

Results

The mean age of the respondents was 31.97 ± 12.51 years, and a majority (58.2%) of the respondents with TB disease were 18 to 38 years old, and 59.9% were males. Around 49.7% of the pulmonary TB patients received a high level of family support, whereas 73% received a high level of social support. The determinants like age, average monthly income, the educational level of the head of the family and the occupational level of both the patients and the head of the family are associated with family support.

Conclusion

This study recommends a coordinated strategy to treat TB that involves not only professional services but also the vital social support network of family and community that is required throughout therapy.
ESG-Linked Compensation, CEO Skills, and Shareholder Welfare
Authors: Homroy Swarnodeep , Mavruk Taylan , Nguyen Van Diem
Published: May 2023

Executive compensation is increasingly being linked to ESG outcomes. This paper examines whether ESG targets are consistent with shareholder welfare. Using granular information on compensation contracts of Swedish CEOs, we show that ESG and financial targets are competing. ESG-linked compensation is 5 percentage points more common in well-governed firms and 6.3 percentage points more likely for CEOs with broader skill sets (generalist CEOs). ESG scores of well-governed firms improve when generalist CEOs have ESG-linked pay, but there is no effect on profitability. These results suggest that boards set ESG contracts because shareholders derive utility from ESG in addition to wealth, and ESG may not be produced without these incentives. (JEL M14, G14, D21, L21)

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Combining multimodal magnetic resonance brain imaging and machine learning to unravel neurocognitive function in non-neuropsychiatric systemic lupus erythematosus
Authors: Tay Sen Hee , Stephenson Mary Charlotte , Allameen Nur Azizah , Ngo Raymond Yeow Seng , Ismail Nadiah Afiqah Binte , Wang Victor Chun Chieh , Totman John James , Cheong Dennis Lai-Hong , Narayanan Sriram , Lee Bernett Teck Kwong , Mak Anselm
Published: May 2023

Objective

To study whether multimodal brain MRI comprising permeability and perfusion measures coupled with machine learning can predict neurocognitive function in young patients with SLE without neuropsychiatric manifestations.

Methods

SLE patients and healthy controls (HCs) (≤40 years of age) underwent multimodal structural brain MRI that comprised voxel-based morphometry (VBM), magnetization transfer ratio (MTR) and dynamic contrast-enhanced (DCE) MRI in this cross-sectional study. Neurocognitive function assessed by Automated Neuropsychological Assessment Metrics was reported as the total throughput score (TTS). Olfactory function was assessed. A machine learning–based model (i.e. glmnet) was constructed to predict TTS.

Results

Thirty SLE patients and 10 HCs were studied. Both groups had comparable VBM, MTR, olfactory bulb volume (OBV), olfactory function and TTS. While after correction for multiple comparisons the uncorrected increase in the blood–brain barrier (BBB) permeability parameters compared with HCs did not remain evident in SLE patients, DCE-MRI perfusion parameters, notably an increase in right amygdala perfusion, was positively correlated with TTS in SLE patients (r = 0.636, false discovery rate P < 0.05). A machine learning–trained multimodal MRI model comprising alterations of VBM, MTR, OBV and DCE-MRI parameters mainly in the limbic system regions predicted TTS in SLE patients (r = 0.644, P < 0.0005).

Conclusion

Multimodal brain MRI demonstrated increased right amygdala perfusion that was associated with better neurocognitive performance in young SLE patients without statistically significant BBB leakage and microstructural abnormalities. A machine learning–constructed multimodal model comprising microstructural, perfusion and permeability parameters accurately predicted neurocognitive performance in SLE patients.
Three-Dimensional Spheroid Culture of Human Mesenchymal Stem Cells: Offering Therapeutic Advantages and In Vitro Glimpses of the In Vivo State
Authors: Yen B Linju , Hsieh Chen-Chan , Hsu Pei-Ju , Chang Chia-Chi , Wang Li-Tzu , Yen Men-Luh
Published: May 2023

As invaluable as the standard 2-dimensional (2D) monolayer in vitro cell culture system has been, there is increasing evidence that 3-dimensional (3D) non-adherent conditions are more relevant to the in vivo condition. While one of the criteria for human mesenchymal stem cells (MSCs) has been in vitro plastic adherence, such 2D culture conditions are not representative of in vivo cell-cell and cell-extracellular matrix (ECM) interactions, which may be especially important for this progenitor/stem cell of skeletal and connective tissues. The 3D spheroid, a multicellular aggregate formed under non-adherent 3D in vitro conditions, may be particularly suited as an in vitro method to better understand MSC physiological processes, since expression of ECM and other adhesion proteins are upregulated in such a cell culture system. First used in embryonic stem cell in vitro culture to recapitulate in vivo developmental processes, 3D spheroid culture has grown in popularity as an in vitro method to mimic the 3-dimensionality of the native niche for MSCs within tissues/organs. In this review, we discuss the relevance of the 3D spheroid culture for understanding MSC biology, summarize the biological outcomes reported in the literature based on such this culture condition, as well as contemplate limitations and future considerations in this rapidly evolving and exciting area.
Indispensable role of Nectin‐like 4 in regulating synapse‐related molecules, synaptic structure, and individual behavior
Authors: Liu Xiao , Ran Kunnian , Hu Geng , Yin Bin , Qiang Boqin , Han Wei , Shu Pengcheng , Peng Xiaozhong
Published: May 2023

Nectin‐like family members (Necls) are involved in synaptic organization. In contrast to that of Necl‐2/CADM1/SynCAM1, which is critical in synaptic events, investigation of Necl‐4/CADM4/SynCAM4 in synapses has largely lagged behind given the particularity of homophilic self‐interactions compared to interactions with other Necls. We sought to further understand the role of Necl‐4 in synapses and found that knockout of Necl‐4 led to aberrant expression levels of proteins mediating synaptic function in cortex homogenates and augmented accumulation of ionotropic glutamate receptor in postsynaptic density fractions, although a compensatory effect of Necl‐1 on the expression levels existed. Concurrently, we also found increased synaptic clefts in the cortex and simplified dendritic morphology of primary cultured cortical neurons. Experiments on individual behaviors suggested that compared to their wild‐type littermates, Necl‐4‐KO mice exhibited impaired acquisition of spatial memory and working memory and enhanced behavioral despair and anxiety‐like behavior. These findings suggest that Necl‐4 mediates synaptic function and related behaviors through an indispensable role and offer a new perspective about collaboration and specialization among Necls.
Mitochondrial quality control in abdominal aortic aneurysm: From molecular mechanisms to therapeutic strategies
Authors: Wang Ding , Jia Longyuan , Zhao Chengdong , Wang Huitao , Dai Zhengnan , Jing Yuchen , Jiang Bo , Xin Shijie
Published: May 2023

Mitochondria are the energy supply sites of cells and are crucial for eukaryotic life. Mitochondrial dysfunction is involved in the pathogenesis of abdominal aortic aneurysm (AAA). Multiple mitochondrial quality control (MQC) mechanisms, including mitochondrial DNA repair, biogenesis, antioxidant defense, dynamics, and autophagy, play vital roles in maintaining mitochondrial homeostasis under physiological and pathological conditions. Abnormalities in these mechanisms may induce mitochondrial damage and dysfunction leading to cell death and tissue remodeling. Recently, many clues suggest that dysregulation of MQC is closely related to the pathogenesis of AAA. Therefore, specific interventions targeting MQC mechanisms to maintain and restore mitochondrial function have become promising therapeutic methods for the prevention and treatment of AAA.
The influence of liver transplantation on the interplay between gut microbiome and bile acid homeostasis in children with biliary atresia
Authors: Waldner Birgit , Aldrian Denise , Zöggeler Thomas , Oberacher Herbert , Oberhuber Rupert , Schneeberger Stefan , Messner Franka , Schneider Anna M. , Kohlmaier Benno , Lanzersdorfer Roland , Huber Wolf-Dietrich , Entenmann Andreas , Müller Thomas , Vogel Georg F.
Published: May 2023

Background:

Biliary atresia (BA) causes neonatal cholestasis and rapidly progresses into cirrhosis if left untreated. Kasai portoenterostomy may delay cirrhosis. BA remains among the most common indications for liver transplantation (LT) during childhood. Liver function and gut microbiome are interconnected. Disturbed liver function and enterohepatic signaling influence microbial diversity. We, herein, investigate the impact of LT and reestablishment of bile flow on gut microbiome–bile acid homeostasis in children with BA before (pre, n = 10), 3 months (post3m, n = 12), 12 months (post12m, n = 9), and more than 24 months (post24 + m, n = 12) after LT.

Methods:

We analyzed the intestinal microbiome of BA patients before and after LT by 16S-rRNA-sequencing and bioinformatics analyses, and serum primary and secondary bile acid levels.

Results:

The gut microbiome in BA patients exhibits a markedly reduced alpha diversity in pre (p = 0.015) and post3m group (p = 0.044), and approximated healthy control groups at later timepoints post12m (p = 1.0) and post24 + m (p = 0.74). Beta diversity analysis showed overall community structure similarities of pre and post3m (p = 0.675), but both differed from the post24 + m (p < 0.001). Longitudinal analysis of the composition of the gut microbiome revealed the Klebsiella genus to show increased abundance in the post24 + m group compared with an age-matched control (p = 0.029). Secondary bile acid production increased 2+ years after LT (p = 0.03). Multivariable associations of microbial communities and clinical metadata reveal several significant associations of microbial genera with tacrolimus and mycophenolate mofetil–based immunosuppressive regimens.

Conclusions:

In children with BA, the gut microbiome shows strongly reduced diversity before and shortly after LT, and approximates healthy controls at later timepoints. Changes in diversity correlate with altered secondary bile acid synthesis at 2+ years and with the selection of different immunosuppressants.
Efficacy of a Pharmacy Resident-Driven Beta-Lactam Allergy Assessment at a Community Hospital
Authors: Shaw Michael , Lally Ryan , Langenderfer Rachel , NeSmith Brittany , Cash Julie , Servais Taylor
Published: May 2023

Background

Beta-lactams are the most commonly used antibiotics, although they are also associated with hypersensitivity reactions. Although approximately 10% of the population report an allergy to a beta-lactam, identifying erroneous beta-lactam allergies can lead to improved patient outcomes and lower rates of antimicrobial resistance.

Methods

This study was a single-center, retrospective review of a pharmacy resident driven beta-lactam allergy assessment. The allergy assessment consisted of a chart review and a 3-question interview. The primary outcome of this study was a composite of the following interventions: beta-lactam allergy delabeling, reaction specification, and/or identification of previously tolerated beta-lactams. Secondary outcomes included patients who were relabeled if delabeling occurred, patients who received beta-lactam therapy after changes occurred to their charted allergy, and impact on hospital utilization of beta-lactam alternative antibiotics.

Results

A total of 42 patients were interviewed between September 13, 2021, and December 17, 2021, with follow-up occurring 90 days after the initial interview. The most common beta-lactam allergy reported was penicillin (90.5%). Of the patients who were assessed, 95.2% met at least one of the components of the primary endpoint. Specifying the previous toleration of beta-lactam agents was the most common intervention, occurring after 78.6% of assessments. Complete delabeling of the patient's beta-lactam allergy occurred after 38.1% of the interviews conducted.

Conclusions

A pharmacy-resident driven beta-lactam allergy assessment was effective at clarifying beta-lactam allergies, including the complete delabeling of erroneous beta-lactam allergies.
Single Transverse Palmar Crease as a Potential Risk Factor for COVID-19
Authors: Kanazawa Satoshi
Published: May 2023

Aims

While South Asians in the United Kingdom suffer from higher mortality from COVID-19, the exact reason for the ethnic disparity is unknown. One solution is to find a genetic correlate of South Asian ethnicity and see if the same correlate is associated with an increased likelihood of COVID-19 contraction among Whites.

Methods

The author analyzed a prospectively longitudinal, nationally representative sample from the British Cohort Study that began at birth in 1970 and has information on COVID-19 health status in May 2020.

Results

Palmer crease patterns measured at age 10 were significantly associated with the likelihood of COVID-19 contraction and the number of symptoms at age 50. Individuals with single transverse palmar crease (STPC) on the right hand had 22.9% chance of contracting COVID-19 compared with 9.5% for those with the normal crease.

Conclusions

Because having STPC on the right hand nearly triples the odds of contracting COVID-19 among Whites, and South Asians are 4 to 5 times as likely to have STPC as Whites do, the genes for/chromosomal abnormalities associated with STPC might be one of the contributors to the higher mortality from COVID-19 among South Asians in the United Kingdom.
Exploration of the Golf-Specific Low Back Pain Questionnaire
Authors: Skibski Andrew , Goetschius John , Mangum L. Colby
Published: May 2023

Objective:

The primary purpose of this study was to determine internal consistency and concurrent validity of the Golf-specific Low Back Pain questionnaire (GLBP).

Design:

Cross-sectional study.

Setting:

Online questionnaire.

Participants:

Fifty-two adult golfers with a history of LBP.

Interventions:

GLBP, Oswestry Disability Index (ODI).

Main Outcome Measures:

Cronbach alpha values for the GLBP and its 3 subscales. Pearson correlations between the ODI, GLBP, and the GLBP subscales.

Results:

Cronbach alpha for the GLBP was 0.94. Cronbach alpha for the 3 GLBP subscales ranged from 0.85 to 0.91. All Pearson correlations were significant at P < 0.05. The correlation between the ODI and GLBP was −0.64, and correlations between the ODI and GLBP subscales ranged from −0.53 to −0.63. Mean GLBP score was 72.01% ± 16.15%, and mean ODI score was 12.00% ± 7.98%.

Conclusions:

The GLBP has excellent concurrent validity to quantify LBP in golfers. The GLBP total and each individual subscale have excellent internal consistency and a moderate inverse relationship with the ODI. The GLBP offers a more sport-specific patient-reported outcome measure for this population. The GLBP may more adequately quantify LBP-related disability, especially at lower levels of disability. Findings provide initial evidence that the GLBP may be a valid tool to quantify LBP symptoms and dysfunction in golfers.

Clinical Relevance:

Clinicians should consider using sport-specific outcome measures when evaluating for LBP-related disability.
The Spectrum of Duodenal Histologic Findings in Patients With Trisomy 21: A Multicenter Study
Authors: Alexander Erin , Stahl Marisa , Weaver Amy , Devara Janaki , Fahey Lisa M. , Singh Arunjot , Leonard Maureen M. , Weisbrod Vanessa , Shull Mary , Silvester Jocelyn , Kramer Zachary , Kerzner Benny , Liu Edwin , Absah Imad
Published: May 2023

Objectives:

Patients with Trisomy 21 (T21) commonly have gastrointestinal symptoms and diseases that prompt evaluation with esophagogastroduodenoscopy (EGD). Our objective is to characterize duodenal histological abnormalities in these patients when undergoing EGD. A secondary aim is to explore associations of histologic findings with different therapies.

Methods:

Patients 30 years old or younger with T21 who underwent EGD from 2000 to 2020 at 6 hospitals were included in this retrospective cohort study. Duodenal biopsies were categorized based on reported histopathology findings as normal or abnormal. Abnormal pathology reports were reviewed and categorized into villous atrophy (VA) and duodenitis without VA. The VA group was further categorized based on the presence or absence of celiac disease (CD).

Results:

We identified 836 patients with T21 who underwent EGD, 419 (50.1%) of whom had duodenal histologic abnormalities. At the time of the first (index) abnormal duodenal biopsy, 290 of 419 had VA and of those, 172 of 290 met CD diagnostic criteria, while 118 of 290 did not meet CD criteria (nonspecific VA). Among the patients with an abnormal biopsy, acid suppression at the time of the index biopsy was less common in patients with VA-CD compared to patients without VA or patients with nonspecific VA (12.2% vs 45.7% vs 44.9%).

Conclusions:

Half of the T21 patients in this cohort had abnormal duodenal biopsies including a subgroup with nonspecific VA. In this cohort, acid suppression use was more prevalent in patients with abnormalities other than CD.
Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study
Authors: Shrestha Nischal , Regmi Priyanka , Shrestha Sneha , Nyaupane Kalpana
Published: May 2023

Introduction:

Caesarean section is performed when there are pregnancy related complications and vaginal delivery cannot be tried or fails. The effect of pandemic lockdown on the availability as well as accessibility of health services is a global concern. The aim of this study was to find out the caesarean section rate and its indication at a tertiary care hospital during COVID-19 pandemic.

Methods:

A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021–30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated.

Results:

Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53–35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24–30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%).

Conclusions:

This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.
Germline mutations of B-Raf proto-oncogene and pathological implications in prostate cancer: observational study
Authors: Tiabi Ikram , Ennaji Youssef , Abumsimir Berjas , Laraqui Abdelilah , Ennibi Khalid , Mrabti Mohammed , Alami Mohammed , Mahasneh Ihsan Ali , Benchekroun Mohammed Nabil , Ennaji Moulay Mustapha
Published: May 2023

Background:

B-Raf proto-oncogene has been found in a variety of neoplasms. BRAF stimulation can promote tumour proliferation through the activation of the MAP/ERK kinase pathway. This study aimed to determine the germline spectra of BRAF and the association with pathological criteria of prostate tumours.

Methods:

Fifty blood samples from men treated with prostate cancer were analyzed for BRAF germline mutations and confirmed by Sanger sequencing, in addition, to establishing the frequencies and clinical correlations of frequent mutations in the BRAF gene for both exon 11 and exon 15. The frequency and distribution of high-frequency mutations were analyzed according to the pathological criteria of the patients.

Results:

Frameshift mutations: c.1628_1629insA and c.1624_1625insT with a frequency of (46%) and (18%), respectively, Nonsense mutations: c.1181C>A (p.Ser394Ter) was detected in one patient, missense mutations: c.1226A>G (p.Gln409Arg), c.1270T>C (p.Trp424Arg), c.1270_1271delins2 (p.Trp424Leu), with a frequency of (4%) were detected. There was no significant difference between mutation carriers and non-carriers regarding medical and surgical history, but prostate-specific antigen concentration was significantly different between the two groups.

Conclusion:

The results of this study elucidate the presence and involvement of germline mutations in prostate cancer, which could serve as a potential indicator for the diagnosis and therapeutic management of prostate cancer in the population studied.
Lack of knowledge regarding the misuse of domperidone in Pakistan and its serious consequences: short communication
Authors: Kalwar Asifa , Mangi Rabel Q. , Rehman Junaid U. , Ochani Sidhant , Faraz Muhammad , Kukreja Sandhaya , Hasibuzzaman Md. Al
Published: May 2023

Domperidone is an antagonist of the peripheral dopamine (D2) receptor. It works as an antiemetic by blocking D2-receptors at the chemoreceptor trigger zone and as a gastroprokinetic drug by blocking GI tract D2-receptors. According to research, using domperidone significantly raises the risk of cardiac arrhythmia and sudden cardiac death by 70%, most likely through prolonging the QT interval. Blockade of hERG voltage-gated potassium channels is thought to be the reason. Here in Pakistan, this drug is being prescribed by every other physician and even patients frequently self-medicate themselves with it. Due to the serious side effects of this medication, extreme caution should be exercised when prescribing it, especially to the elderly, those who have underlying QT prolongation, those taking medications known to prolong QT, and even more so in pregnant women as there is some evidence that domperidone crosses into breast milk in small amounts and causes an irregular heartbeat in the baby. At least we, on our part, can limit the usage of the drug only with a prescription and, where necessary, if not completely, stop it.
The benefit of antibiotic-combined Mg-hydroxyapatite bone graft substitute over autologous bone for surgical site infection prevention in posterolateral spinal fusion: a retrospective cohort study
Authors: Zanotti Bruno , Muggiolu Francesco , De Maria Lucio
Published: May 2023

Study Design:

Retrospective cohort study.

Objective:

The authors’ goal was to clarify whether a bone substitute combined with antibiotics might gain a hold in spinal surgery as a preventive treatment for early infections (EIs).

Background:

A relatively infrequent but severe complication in spinal surgery is the occurrence of EIs.

Methods:

The authors retrospectively compared a population undergoing posterolateral fusion with Mg-enriched hydroxyapatite paste mixed with 60 mg rifampicin powder, with a matched population treated with autologous bone without antibiotics. A total of 30 patients from 2020 to 2021 were included in our study. We estimated EI’s relative risk and the number needed to treat. Statistical analyses were performed using the R statistical package v3.4.1 (http://www.r-project.org).

Results:

No early infections occurred in the population treated with antibiotic-combined bone substitutes, compared with 6.7% of patients treated with autologous bone without antibiotics. The relative risk of EIs was 0.33 (P=.49; 95% CI=0.01–7.58) and the number needed to treat was 15.

Conclusions:

The results support the hypothesis that combining bone substitutes with antibiotics may decrease the risk of EIs and could be a viable option to improve spinal surgery outcomes. However, a larger sample size would be needed to confirm the benefit of rifampicin-combined Mg-enriched hydroxyapatite substitutes over autologous bone for surgical site infection prevention.

Level of Evidence:

Level 3.
Closing potential drivers of antimicrobial resistance: last-resort antimicrobials with the potential of being misused, the way forward – a short communication
Authors: Miteu Goshen D. , Achinebiri Praise , Raghunathan Narasimhan , Sankaran Sathyanarayanan
Published: May 2023

Antimicrobial resistance (AMR) is still a formidable global public health challenge, as microorganisms, including bacteria, viruses, fungi, and parasites, evolve resistance to commonly used drugs, particularly antibiotics. The preservation of last-resort antimicrobials is critical for treating multi-drug-resistant infections; however, their indiscriminate use can exacerbate AMR crisis. This short communication delves into the multifaceted challenges, innovative strategies, and promising future directions to combat AMR effectively. Factors such as inappropriate prescription practices and the dearth of novel antibiotics contribute to the emergence of AMR. By implementing antimicrobial stewardship programs and fostering public education, we can mitigate the misuse of these vital drugs. Future research endeavors should concentrate on the development of cutting-edge drugs and diagnostic technologies to address AMR with enhanced precision and efficiency. Additionally, robust surveillance systems are crucial for monitoring antibiotic use and resistance patterns, providing valuable insights to inform policy decisions. A concerted, collaborative effort from governments, policymakers, healthcare providers, researchers, and other stakeholders is indispensable for overcoming the global health crisis posed by AMR.
Knowledge, attitude, practice and their associated determinants, in relation to updated coronavirus illness 19 prevention and control among Dessie town residents in the South Wollo Zone of Northeast Ethiopia: community-based cross-sectional study cross-sectional study
Authors: Belay Mulusew Zeleke , Wondyifraw Endalk Birrie , Yirdaw Lehulu Tilahun , Tefera Birhanu Desu
Published: May 2023

Background:

Coronavirus disease19 is an emerging respiratory disease caused by a novel coronavirus. The two strains of coronavirus were severe acute respiratory syndrome-coronavirus, and Middle East respiratory syndrome-coronavirus. A sudden outbreak of coronavirus disease 2019 (COVID-2019) caused by infection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The objective of this study was to analyse the community’s knowledge, attitude, and practice and their associated determinants, in relation to updated COVID19 prevention and control in South Wollo Zone, Ethiopia.

Materials and methods:

Community-based prospective cross sectional study was conducted from 10 April to 30 July 2020. The study population was selected from Dessie town and 423 samples were collected using systemic random sampling technique through self-administered questionnaire and verified, coded, and entered into epidata software and it export to SPSS for analysis. To summarise descriptive statistics frequencies, percentage, mean, and median were used and presented with tables, charts, and figures.

Results:

The participation rate was 93.6%. Among the respondents 53.5% had solid knowledge; 50% had a positive attitude, and 45.2% had good COVID19 practice. Single marital status [adjusted odds ratio (AOR) (95% CI) = 0.487 (0.294–0.809)] and physical labour in occupation [AOR (95% CI) = 2.87 (1.003–8.214)] were both linked to strong COVID19 knowledge. Age of 30–34 [AOR (95% CI) = 2.264 (1.04–4.92)], age of 45–49 [AOR (95% CI) = 4.79 (1.22–18.77)], good knowledge [AOR (95% CI) = 1.58 (1.01–2.498)], good practice [AOR (95% CI) = 2.88 (1.754–4.72)] were significantly associated with adequate attitude, in the other hand sex [AOR (95% CI) = 3.03 (1.72–5.34)], educational status [AOR (95% CI)= 26.23 (3.83–179.84)], jobless occupation [AOR (95% CI)=0.212 (0.079–0.572)], age, and adequate attitude were all linked to good coronavirus disease practice 19.

Conclusions:

More than half, half, and less than half of the participants, respectively, had knowledge, attitude, and practice of COVID19 in Dessie town.