bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative efficacy and safety of hypnotics for insomnia in older adults: a systematic review and network meta-analysis
Authors: Chiu Hsiao-Yean , Lee Hsin-Chien , Liu Jen-Wei , Hua Shi-Jun , Chen Pin-Yuan , Tsai Pei-Shan , Tu Yu-Kang
Published: November 2020

Study Objectives

To compare the efficacy and safety of various hypnotics for identifying the best treatments for insomnia in older adults.

Methods

We searched the EMBASE, PubMed, ClinicalTrials.gov, and ProQuest Dissertations and Theses A&I databases from the inception to September 12, 2020. Only randomized controlled trials comparing hypnotics with either another hypnotic or placebo for insomnia treatment in elderly people were included. Sleep outcomes, including total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, were derived from polysomnography, valid questionnaires, or sleep diaries.

Results

We identified 24 articles with 5917 older adults. Eszopiclone and low-dose doxepin were ranked the optimal therapy for prolonging objective and subjective total sleep time (26.69 and 28.19 min), respectively, compared to placebo. Zaleplon was the most effective therapy in reducing objective and subjective sleep onset latency (–21.63 and –15.86 min) compared with control. Temazepam was the best treatment for objective and subjective wake after sleep onset (–25.29 and –22.25 min) compared with control. Low-dose doxepin appeared to be the effective treatment for increasing objective sleep efficiency (6.08%) Triazolam showed the higher risk of overall adverse events (odds ratio, 1.96, 95% confidence interval 1.03–3.74) when compared to zaleplon.

Conclusions

Considering study quality and the potential adverse effects of benzodiazepines and nonbenzodiazepines, low-dose doxepin seems to be the optimal pharmacotherapy for the improvements in total sleep time and sleep efficiency. Future RCTs investigating the treatment effects of hypnotics, particularly low-dose doxepin, on insomnia in older adults are warranted.

PROSPERO Registration number: CRD42016046301.
Disparities in Documented Drug Use Disorders Between Transgender and Cisgender U.S. Veterans Health Administration Patients
Authors: Frost Madeline C. , Blosnich John R. , Lehavot Keren , Chen Jessica A. , Rubinsky Anna D. , Glass Joseph E. , Williams Emily C.
Published: November 2020

Objectives:

Transgender people—those whose gender identity differs from their sex assigned at birth—are at risk for health disparities resulting from stressors such as discrimination and violence. Transgender people report more drug use than cisgender people; however, it is unclear whether they have higher likelihood of drug use disorders. We examined whether transgender patients have increased likelihood of documented drug use disorders relative to cisgender patients in the national Veterans Health Administration (VA).

Methods:

Electronic health record data were extracted for VA outpatients from 10/1/09 to 7/31/17. Transgender status and past-year documentation of drug use disorders (any, opioid, amphetamine, cocaine, cannabis, sedative, hallucinogen) were measured using diagnostic codes. Logistic regression models estimated odds ratios for drug use disorders among transgender compared to cisgender patients, adjusted for age, race/ethnicity and year. Effect modification by presence of ≥1 mental health condition was tested using multiplicative interaction.

Results:

Among 8,872,793 patients, 8619 (0.1%) were transgender. Transgender patients were more likely than cisgender patients to have any drug use disorder (Adjusted Odds Ratio [aOR] 1.67, 95% confidence interval [CI] 1.53–1.83), amphetamine (aOR 2.22, 95% CI 1.82–2.70), cocaine (aOR 1.59, 95% CI 1.29–1.95), and cannabis (aOR 1.82, 95% CI 1.62–2.05) use disorders. There was no significant interaction by presence of ≥1 mental health condition.

Conclusions:

Transgender VA patients may have higher likelihood of certain drug use disorders than cisgender VA patients, particularly amphetamine use disorder. Future research should explore mechanisms underlying disparities and potential barriers to accessing treatment and harm reduction services faced by transgender people.
Management of infected nonunions of the femur and tibia with compression-distraction osteogenesis coupled with modern methods at a tertiary military establishment: a prospective case series
Authors: Kaul Rajiv , Akhoon Neha , Mugdum Girish , Prasad Manish
Published: November 2020

Background:

Infected nonunions pose a daunting challenge to any orthopaedic surgeon. The essence of treatment is a radical debridement for eradication of infection coupled with various approaches to address the bone gap. Bone transport and acute docking along with a corticotomy and distraction osteogenesis have stood the test of time. Our purpose was to evaluate the treatment outcome of the modified Ilizarov technique in infected nonunions of the femur and tibia.

Methods:

Twenty-six patients with infected femoral and tibial nonunions underwent aggressive debridement and either bifocal compression-distraction osteogenesis or bone transport using an Ilizarov frame. Adjuvant methods such as local antibiotic delivery systems, bone marrow aspirate concentrate (BMAC) injections, pulsatile recombinant parathyroid hormone (PTH) injections, and negative pressure wound therapy (NPWT) were deployed, as deemed necessary, in specific situations.

Results:

The mean follow-up period was 24.2 mo. The mean time to union was 267.7 days. Union was achieved in 25 cases with complete eradication of infection. Bone results as per the Association for Study of Application of Methods of Ilizarov (ASAMI) scoring system were excellent in 19 patients, good in four, fair in two, and poor in one. The average duration for external fixation was 8.9 mo. Complications occurred in 30.8% of patients.

Conclusions:

The Ilizarov method, by itself or in combination with modern methods, gives satisfactory bone and functional results. Complication rates depend upon the surgeon’s adherence to the cardinal principles of Ilizarov.

Level of Evidence:

Level IV.
Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients
Authors: Kyogoku Miyako , Shimatani Tatsutoshi , Hotz Justin C. , Newth Christopher J. L. , Bellani Giacomo , Takeuchi Muneyuki , Khemani Robinder G.
Published: November 2020

OBJECTIVES:

Inspiratory holds with measures of airway pressure to estimate driving pressure (elastic work) are often limited to patients without respiratory effort. We sought to evaluate if measures of airway pressure during inspiratory holds could be used for patients with spontaneous respiratory effort during mechanical ventilation to estimate the degree of spontaneous effort and elastic work.

DESIGN:

We compared the direction and degree of change in airway pressure during inspiratory holds versus esophageal pressure through secondary analysis of physiologic data.

SETTING:

ICUs at Children’s Hospital Los Angeles.

PATIENTS:

Children with pediatric acute respiratory distress syndrome with evidence of spontaneous respiration while on pressure control or pressure support ventilation.

INTERVENTIONS:

Inspiratory hold maneuvers.

MEASUREMENTS AND MAIN RESULTS:

From airway pressure, we defined “plateau – peak pressure” as Pmusc, index, which was divided into three categories for analysis (< –1 [“negative”], between –1 and 1 [“neutral”], and > 1 cm H2O [“positive”]). A total of 30 children (age 36.8 mo [16.1–70.3 mo]) from 65 study days, comprising 118 inspiratory holds were included. Pmusc, index was “negative” in 29 cases, was “neutral” in 17 cases, and was “positive” in 72 cases. As Pmusc, index went from negative to neutral to positive, there was larger negative deflection in esophageal pressure –5.0 (–8.2 to 1.9), –5.9 (–7.6 to 4.3), and –10.7 (–18.1 to 7.9) cm H2O (p < 0.0001), respectively. There was a correlation between max negative esophageal pressure and Pmusc, index (r = –0.52), and when Pmusc, index was greater than or equal to 7 cm H2O, the max negative esophageal pressure was greater than 10 cm H2O. There was a stronger correlation between Pmusc, index and markers of elastic work from esophageal pressure (r = 0.84).

CONCLUSIONS:

The magnitude of plateau minus peak pressure during an inspiratory hold is correlated with the degree of inspiratory effort, particularly for those with high elastic work. It may be useful to identify patients with excessively high effort or high driving pressure.
Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1: interim analysis of the randomized, controlled, phase 3, non-inferiority TALENT study
Authors: Su Bin , Yao Cheng , Zhao Qing-Xia , Cai Wei-Ping , Wang Min , Lu Hong-Zhou , Chen Yuan-Yuan , Liu Li , Wang Hui , He Yun , Zheng Yu-Huang , Li Ling-Hua , Chen Jin-Feng , Yu Jian-Hua , Zhu Biao , Zhao Min , Sun Yong-Tao , Lun Wen-Hui , Xia Wei , Sun Li-Jun , Dai Li-Li , Jiang Tai-Yi , Wang Mei-Xia , Zheng Qing-Shan , Peng Hai-Yan , Wang Yao , Lu Rong-Jian , Hu Jian-Hua , Xing Hui , Shao Yi-Ming , Xie Dong , Zhang Tong , Zhang Fu-Jie , Wu Hao
Published: November 2020

Background

Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.

Methods

We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.

Results

At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.

Conclusions

The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.

Trial registration

ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.

Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx
A Review of Neuronal Pathways Associated With Consciousness
Authors: Mulkey Malissa , Everhart D. Erik , Gencarelli Amy , Sorrell Anne , Kim Sungham
Published: November 2020

INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.
Embolic Stroke of Undetermined Source: A Primer for Nursing
Authors: Sutherly Loretta J. , Belair Trina , Nahab Fadi
Published: November 2020

BACKGROUND: Cryptogenic stroke has been used to identify ischemic strokes with no identified cause; however, this classification is limited by the lack of a standardized and thorough evaluation. Embolic Stroke of Undetermined Source is used to define those strokes with no identified cause after a standardized diagnostic workup. METHODS: We conducted a literature review from January 1, 2014, to July 31, 2020 including the term “ESUS.” RESULTS: Embolic stroke of undetermined source accounts for approximately 25% of ischemic strokes and is used to classify patients with no identified cause of stroke despite routine brain imaging, noninvasive vascular imaging of the head and neck, a minimum of 24 hours of cardiac monitoring, and echocardiography. Studies have shown that these strokes may be caused by occult atrial fibrillation, occult malignancy, and other hypercoagulable states but are often identified after hospital discharge. The risk of recurrent stroke in ESUS patients remains high at 4.5% per year on single antiplatelet therapy. Ongoing research aims to identify biomarkers that can identify ESUS subgroups who may benefit from alternative antithrombotic therapies. CONCLUSION: Because of the complexity of the evaluation and the uncertainty associated with an unknown cause of stroke, neuroscience nurses caring for these patients should be familiar with ESUS and educate the patient about the condition and the importance of complying with all prescribed treatments, tests, and subsequent follow-up appointments after discharge.
Pancreatic Fungal Infection in Patients With Necrotizing Pancreatitis
Authors: Singh Ritu R. , Mitchell William , David Yakira , Cheesman Antonio , Dixon Rebekah E. , Nagula Satish , DiMaio Christopher J. , Greenwald David A. , Kumta Nikhil A.
Published: November 2020

Goal:

The goal of this study was to study the incidence of fungal infection in necrotizing pancreatitis (NP) and its impact on mortality.

Background:

Infected pancreatic necrosis is a major contributor to morbidity and mortality in patients with NP. While pancreatic fungal infection (PFI) has frequently been identified in patients with NP, its effect on the clinical outcomes is unclear.

Materials and Methods:

A literature search was performed in Medline (Ovid), Embase (Ovid), and the Cochrane library. All prospective and retrospective studies that examined the incidence of fungal infection in NP with subgroup mortality data were included. For fungal infection of NP, studies with fungal isolation from pancreatic necrotic tissue were included. Newcastle Ottawa Scale and Joanna Briggs Institute’s critical appraisal tool were used for bias assessment.

Results:

Twenty-two studies comprising 2151 subjects with NP were included for the quantitative analysis. The mean incidence of fungal infection was 26.6% (572/2151). In-hospital mortality in the pooled sample of NP patients with PFI (N=572) was significantly higher [odds ratio (OR)=3.95, 95% confidence interval (CI): 2.6-5.8] than those without PFI. In a separate analysis of 7 studies, the mean difference in the length of stay between those with and without fungal infection was 22.99 days (95% CI: 14.67-31.3). The rate of intensive care unit admission (OR=3.95; 95% CI: 2.6-5.8), use of prophylactic antibacterials (OR=2.76; 95% CI: 1.31-5.81) and duration of antibacterial therapy (mean difference=8.71 d; 95% CI: 1.33-16.09) were all significantly higher in patients with PFI. Moderate heterogeneity was identified among the studies on estimating OR for mortality (I
2=43%) between the 2 groups.

Conclusions:

PFI is common in patients with NP and is associated with increased mortality, intensive care unit admission rate, and length of stay. Further prospective studies are needed to better understand the pathophysiology of PFIs and to determine the role for preemptive therapeutic strategies, such as prophylactic antifungal therapy.
Knowledge of 5-aminosalicylic acid nephrotoxicity and adherence to kidney function monitoring of patients with inflammatory bowel disease
Authors: Weislinger Lucie , Guillo Lucas , D’Amico Ferdinando , Danese Silvio , Achit Hamza , Ayav Carole , Guillemin Francis , Peyrin-Biroulet Laurent , Frimat Luc
Published: November 2020

Background and aim

5-Aminosalicylic acid (5-ASA) nephrotoxicity is a rare and idiosyncratic condition in patients with inflammatory bowel disease (IBD), which may lead to end-stage kidney failure. Kidney function monitoring is recommended in clinical practice to prevent this complication. However, no data is available regarding the knowledge and adherence of patients with IBD to this monitoring.

Methods

As a part of routine practice, patients with IBD under treatment or previously treated with 5-ASA were systematically interviewed about knowledge of 5-ASA nephrotoxicity and adherence to kidney function monitoring. We reported here the experience among the first 103 consecutive patients seen in a French referral center.

Results

A total of 103 patients (93.2% ulcerative colitis, 5.8% Crohn’s disease, and 1% unclassified colitis) were analyzed. Among them, 70% were informed about the need for kidney function monitoring, and in most cases, information was provided by their gastroenterologist (94.4%). The adherence rate to monitoring was very high (84.7%). Monitoring consisted of serum creatinine and estimated glomerular filtration rate in most cases (97.2%), while 24-h proteinuria was less frequently used (69.4%). These tests were performed twice or ≥3 times per year by 44.4 and 41.7% of patients, respectively. One case of isolated elevation of proteinuria related to 5-ASA treatment was observed.

Conclusion

We reported for the first time that patients with IBD are well informed and adherent to kidney function monitoring of treatment with 5-ASA. The monitoring performed by their treating physician was generally in accordance with current recommendations.
Management of primary biliary cholangitis: results from a large real-life observational study in France and Belgium
Authors: Pariente Alexandre , Chazouilleres Olivier , Causse Xavier , Hanslik Bertrand , Arpurt Jean-Pierre , Henrion Jean , Rosa Isabelle , Renou Christophe , Garioud Armand , Corpechot Christophe ,   on behalf of DESCRIPT and DESCRIPT Study Groups
Published: November 2020

Background and aims:

To assess the characteristics, care, treatment response, and outcomes of primary biliary cholangitis (PBC) patients recently followed-up by hepato-gastroenterologists in various French and Belgian healthcare settings.

Methods:

This retrospective cohort study included patients with PBC who recently visited 79 hepato-gastroenterologists in France and Belgium. Data were collected at the time of diagnosis and at last visit and were compared according to biochemical response (BR) to ursodeoxycholic acid (UDCA) (BR), using Paris I–II criteria, and clinical outcomes.

Results:

A total of 436 patients (mean age at diagnosis 57 years, 88% females, median follow-up 5.2 years) were included. Liver biopsy, transient elastography, or none of these two procedures were performed at baseline in 216 (50%), 194 (45%), and 107 (25%) patients, respectively. Late-stage disease (histological stage III or IV, or transient elastography ≥9.6 kPa, or bilirubin >17 µM and albumin <35 g/L, or platelets <150.000/µl, or unequivocal signs of portal hypertension or cirrhosis) was reported in 37% of patients. UDCA was taken by 95% of patients (27% had suboptimal dosage). Inadequate BR was observed in 37% of patients. Clinicians overestimated disease control. Liver-related complications occurred in 9% of patients. Bilirubin and albumin independently predicted inadequate BR; advanced disease stage and inadequate BR independently predicted complications.

Conclusions:

Recently followed-up French and Belgian patients with PBC had homogeneous management. Late stage at diagnosis and inadequate BR were reported in around 40% of patients. Disease control was frequently overestimated by clinicians. Disease stage and BR were the main prognostic factors.
Incremental value of regional wall motion abnormalities for detecting obstructive coronary artery disease by rest-only electrocardiogram-gated single-photon emission computerized tomography myocardial perfusion imaging in suspected coronary artery disease patients
Authors: Liu Bao , Yu Wenji , Wang Jianfeng , Shao Xiaoliang , Zhang Feifei , Yang Minfu , Yang Xiaoyu , Wu Zhifang , Li Sijin , Shi Yunmei , Wang Bing , Xu Yiduo , Wang Yuetao
Published: November 2020

Objective

The purpose of this study was to determine whether regional wall motion (WM) abnormalities by rest-only 99mtechnetium-sestamibi (99mTc-MIBI) electrocardiogram (ECG)-gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had incremental diagnostic value for detecting obstructive coronary artery disease (CAD) in suspected CAD patients.

Methods

This study retrospectively studied 255 consecutive suspected CAD patients who underwent rest-only ECG-gated SPECT MPI and were performed coronary angiography within 3 months. Obstructive CAD was defined as ≥70% narrowing of the inner diameter of the left anterior descending coronary artery, left circumflex coronary artery and right coronary artery or their main branches and ≥50% narrowing of the left main coronary artery. QPS and QGS were used to assess rest perfusion and WM. Summed rest score ≥4 and summed motion score ≥2 exhibited in two consecutive segments in one territory was considered abnormal.

Results

The sensitivity of the combination of perfusion and regional WM abnormalities was significantly higher than perfusion alone for detecting obstructive CAD (46.8% vs. 30.9%; P < 0.001), with similar specificity (91.9% vs. 95.0; P = 0.063). The global chi-square value of combination of perfusion and WM increased from 31.40 to 50.71 (P < 0.001) compared to perfusion. The sensitivity of combination of perfusion and WM for detecting obstructive CAD in patients with multivessel disease was higher than single-vessel disease (56.1% vs. 25.0%; P < 0.001), with similar specificity.

Conclusion

Regional WM abnormalities at rest, as shown by rest-only 99mTc-MIBI ECG-gated SPECT MPI, have additional diagnostic value over perfusion alone for detecting obstructive CAD in suspected CAD patients.
Correlates of Aerobic and Strength Exercise in Korean Cancer Patients
Authors: An Ki-Yong , Kang Dong-Woo , Courneya Kerry S.
Published: November 2020

Background

Understanding the prevalence and correlates of exercise in Korean cancer patients is important to improve their health-related fitness and quality of life.

Objective

The aim of this study was to examine the prevalence and correlates of aerobic and strength exercise in Korean cancer patients.

Methods

Overall, 640 cancer patients from the Korea National Health and Nutrition Examination Survey 2014–2016 were categorized as meeting the exercise guidelines as follows: (a) neither, (b) strength only, (c) aerobic only, or (d) combined. Correlates included demographic, medical, health-related fitness, and quality of life variables. Univariate and stepwise multinomial logistic regression were used for statistical analyses.

Results

Over 70% of Korean cancer patients did not meet either exercise guideline. Higher education was associated with being more likely to meet the combined (odds ratio [OR], 4.69; P < .001), aerobic-only (OR, 3.58; P < .001), and strength-only (OR, 1.87; P = .042) guidelines. Higher hand-grip strength (per 10 kg) was associated with being more likely to meet the combined (OR, 1.78; P = .003) and strength-only (OR, 1.73; P < .001) guidelines. Older age (per 10 years) was associated with being less likely to meet the combined (OR, 0.69; P = .009) and aerobic-only (OR, 0.59; P < .001) guidelines and more likely to meet the strength-only guideline (OR, 1.46; P = .004).

Conclusions

Exercise levels are very low among Korean cancer patients and are correlated with age, education, and physical strength.

Implications for Practice

Oncology nurses in Korea should consider promoting exercise to cancer patients, especially older, less educated, and physically weaker patients.
Standardizing Outcome Assessment in Parkinson Disease: A Knowledge Translation Project
Authors: Yorke Amy M. , Trojanowski Suzanne , Fritz Nora E. , Ludwa Angee , Schroeder Matthew
Published: November 2020

Background and Purpose:

Rehabilitation therapists do not consistently utilize standardized outcome measures. The purpose of this study was to develop and implement a tailored knowledge translation (KT) intervention to facilitate application of standardized outcome measures used in patients with Parkinson disease (PD) receiving outpatient rehabilitation.

Methods:

Four clinics within a hospital-based outpatient system including physical therapists (n = 7) and occupational therapists (n = 2) collaborated with researcher clinicians. A mixed-methods study, using the knowledge to action (KTA) framework, was executed to standardize the assessment battery completed on patients with PD. The project was titled iKNOW-PD (integrating KNOWledge translation for Parkinson Disease).

Results:

Four measures were selected for iKNOW-PD (9-Hole Peg Test, miniBESTest, 10-m walk test, and 5 times sit-to-stand). A multimodal intervention that overcame specific identified barriers (equipment, time) was implemented to ensure successful uptake. Consistency of utilizing iKNOW-PD measures on initial evaluation and discharge, across therapists and clinics, was evaluated. Therapists significantly increased the use of iKNOW-PD measures from 1.9 to 3.1 on initial evaluation (P < 0.001). The 10-meter walk test demonstrated the greatest uptake (>50%) from pre-iKNOW-PD to post-iKNOW-PD.

Discussion and Conclusions:

Standardizing outcome assessment for persons with PD in an outpatient setting can be successfully implemented. Overcoming identified barriers and capitalizing on facilitators promoted the uptake of standardized outcomes. Following the 6-month intervention period, therapists endorsed an improvement in their application of standardized measures and labeled iKNOW-PD as a positive experience that allowed them to minimize variability in practice.

Video Abstract available for more insights from the authors (see the Video, Supplemental Content 1, available at: http://links.lww.com/JNPT/A329).
HIV in Iran: onset, responses, and future directions
Authors: SeyedAlinaghi SeyedAhmad , Taj Leila , Mazaheri-Tehrani Elham , Ahsani-Nasab Sara , Abedinzadeh Negin , McFarland Willi , Mohraz Minoo , Mirzazadeh Ali
Published: November 2020

Iran, a country in the Middle East and North Africa (MENA) region, has been actively involved in the fight against HIV/AIDS over the past three decades. The unique features of the HIV epidemic in Iran are reflected by the modes of transmission and its recent changes to improve management and prevention programs. In this review, we recount the initial onset and subsequent spread of HIV infection in Iran, beginning with the first case diagnosed to the ongoing responses and most recent achievements in controlling this epidemic. Although in the MENA region, Iran is one of the pioneers in implementing pertinent policies including harm reduction services to decrease HIV incidence, drug injection still continues to be the major risk of infection. In line with other nations, the programs in Iran aim at the UNAIDS 90-90-90 targets (UNAIDS 90-90-90 global targets to end the AIDS epidemic by 2020: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression) and to eliminate mother-to-child HIV transmission. In this article, we discuss the strengths and shortcomings of the current HIV programs and offer suggestions to provide a better perspective to track and respond to the HIV epidemic. More generally, our account of the national religious and cultural circumstances as well as obstacles to the approaches chosen can provide insights for decision-makers in other countries and institutions with comparable settings and infrastructures.
Optimizing respondent-driven sampling to find undiagnosed HIV-infected people who inject drugs
Authors: McFall Allison M. , Lau Bryan , Latkin Carl , Srikrishnan Aylur K. , Anand Santhanam , Vasudevan Canjeevaram K. , Mehta Shruti H. , Solomon Sunil S.
Published: November 2020

Objective:

We evaluated whether identification of undiagnosed HIV-infected people who inject drugs (PWID) via respondent-driven sampling (RDS) can be enhanced through a precision RDS (pRDS) approach.

Design/methods:

First, using prior RDS data from PWID in India, we built a prediction algorithm for recruiting undiagnosed HIV-infected PWID. pRDS was tested in Morinda, Punjab where participants were randomly assigned to standard or pRDS. In the standard RDS approach, all participants received two recruitment coupons. For pRDS, the algorithm determined an individual's probability of recruiting an undiagnosed PWID, and individuals received either two (low probability) or five (high probability) coupons. Efficiency in identifying undiagnosed HIV-infected PWID for the RDS approaches was evaluated in two ways: the number needed to recruit (NNR) and identification rate/week.

Results:

Predictors of recruiting undiagnosed PWID included HIV/HCV infection, network size, syringe services utilization, and injection environment. 1631 PWID were recruited in Morinda. From the standard RDS approach, 615 were recruited, including 39 undiagnosed; from pRDS, 1012 were recruited, including 77 undiagnosed. In pRDS, those with higher predicted probability were more likely to recruit others with HIV/HCV co-infection, undiagnosed and viremic HIV, and who utilized services. pRDS had a significantly higher identification rate of undiagnosed PWID (1.5/week) compared with the standard (0.8/week). The NNR for pRDS (13.1) was not significantly lower than the standard approach (15.8).

Conclusion:

pRDS identified twice as many undiagnosed and viremic PWID significantly faster than the standard approach. Leveraging RDS or similar network-based strategies should be considered alongside other strategies to ensure meeting UNAIDS targets.
Pharmacokinetics of tenofovir alafenamide with and without cobicistat in pregnant and postpartum women living with HIV
Authors: Brooks Kristina M. , Momper Jeremiah D. , Pinilla Mauricio , Stek Alice M. , Barr Emily , Weinberg Adriana , Deville Jaime G. , Febo Irma L. , Cielo Mikhaela , George Kathleen , Denson Kayla , Rungruengthanakit Kittipong , Shapiro David E. , Smith Elizabeth , Chakhtoura Nahida , Rooney James F. , Haubrich Richard , Espina Rowena , Capparelli Edmund V. , Mirochnick Mark , Best Brookie M.
Published: November 2020

Objective:

To evaluate the pharmacokinetics of tenofovir alafenamide (TAF) 10 mg with cobicistat and 25 mg without boosting in pregnant and postpartum women with HIV and to characterize TAF placental transfer and infant washout pharmacokinetics.

Design:

Open-label, multicenter phase IV prospective study of TAF pharmacokinetics during pregnancy, postpartum, delivery, and infant washout.

Methods:

Pregnant women receiving TAF 10 mg with cobicistat or TAF 25 mg without boosting as part of clinical care had intensive pharmacokinetic assessments performed during the second and third trimesters, and 6–12 weeks postpartum. Maternal and cord blood samples were collected at delivery, and washout pharmacokinetic samples were collected in infants. TAF concentrations were quantified using liquid chromatography/mass spectrometry. Comparisons between pregnancy and postpartum were made using geometric mean ratios (90% confidence intervals) and Wilcoxon signed-rank tests.

Results:

Thirty-one pregnant women receiving TAF 10 mg with cobicistat-boosting and 27 women receiving TAF 25 mg without boosting were enrolled. TAF exposures did not significantly differ between pregnancy and postpartum when administered as 10 mg with cobicistat. Antepartum TAF exposures with the 25 mg dose were 33–43% lower in comparison with postpartum, but comparable with those measured in nonpregnant adults. TAF was below the lower limit of quantitation in 43 of 44 cord blood, 41 of 45 maternal blood at delivery, and all infant washout samples.

Conclusion:

TAF exposures were comparable or higher than those measured in nonpregnant adults during pregnancy and postpartum. These findings provide reassurance on adequate TAF exposures during pregnancy, and support efforts to expand the use of TAF in pregnant women with HIV.
Mitochondrial DNA haplogroups and weight gain following switch to integrase strand transfer inhibitor-based antiretroviral therapy
Authors: Erlandson Kristine M. , Wu Kunling , Lake Jordan E. , Samuels David C. , Bares Sara H. , Tassiopoulos Katherine , Koethe John R. , Brown Todd T. , Leonard Michael , Benson Constance A. , Haas David W. , Hulgan Todd
Published: November 2020

Background:

Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) has been associated with excess weight gain in some adults, which may be influenced by genetic factors. We assessed mitochondrial DNA (mtDNA) haplogroups and weight gain following switch to INSTI-based ART.

Methods:

All AIDS Clinical Trials Group A5001 and A5322 participants with mtDNA genotyping who switched to INSTI were included. mtDNA haplogroups were derived from prior genotyping algorithms. Race/ethnicity-stratified piecewise linear mixed effects models assessed the relationship between mtDNA haplogroup and weight change slope differences before and after switch to INSTI.

Results:

A total of 291 adults switched to INSTI: 78% male, 50% non-Hispanic White, 28% non-Hispanic Black, and 22% Hispanic. The most common European haplogroups were H [n = 66 (45%)] and UK [32 (22%)]. Non-H European haplogroups had a significant increase in weight slope after the switch. This difference was greatest among non-H clade UK on INSTI-based regimens that included tenofovir alafenamide (TAF) [3.67 (95% confidence interval 1.12, 6.21) kg/year; P = 0.005]. Although small sample size limited analyses among non-Hispanic Black and Hispanic persons, similarly significant weight gain was seen among the most common African haplogroup, L3 [n = 29 (39%); slope difference 4.93 (1.54, 8.32) kg/year, P = 0.005], after switching to TAF-containing INSTI-based ART.

Conclusion:

Those in European mtDNA haplogroup clade UK and African haplogroup L3 had significantly greater weight gain after switching to INSTI-based ART, especially those receiving TAF. Additional studies in large and diverse populations are needed to clarify the mechanisms and host risk factors for weight gain after switching to INSTI-based ART, with and without TAF.
Losartan to reduce inflammation and fibrosis endpoints in HIV disease
Authors: Baker Jason V. , Wolfson Julian , Collins Gary , Morse Caryn , Rhame Frank , Liappis Angelike P. , Rizza Stacey , Temesgen Zelalem , Mystakelis Harry , Deeks Steven , Neaton James , Schacker Timothy , Sereti Irini , Tracy Russell P.
Published: November 2020

Background:

Persistent inflammation and incomplete immune recovery among persons with HIV (PHIV) are associated with increased disease risk. We hypothesized that the angiotensin receptor blocker (ARB) losartan would reduce inflammation by mitigating nuclear factor (NF)κB responses and promote T-cell recovery via inhibition of transforming growth factor-beta (TGFβ)-mediated fibrosis.

Methods:

Losartan (100 mg) versus placebo over 12 months was investigated in a randomized (1 : 1) placebo-controlled trial, among PHIV age at least 50 years, receiving antiretroviral therapy (ART), with HIV RNA less than 200 copies/ml and CD4+ cell count 600 cells/μl or less. Inflammation, fibrosis and myocardial biomarkers were measured in blood using ELISA, electrochemiluminescence and immunoturbidimetric methods, and T-cell and monocyte phenotypes were assessed with flow cytometry among a subset of participants. Changes over follow-up in (log-2 transformed) biomarkers and cell phenotypes (untransformed) were compared between losartan and placebo arms using linear mixed models.

Results:

Among 108 PHIV (n = 52 to losartan; n = 56 to placebo), 97% had a month 12 visit. Median age was 57 years and baseline CD4+ cell count was 408 cells/μl. Losartan treatment was not associated with an improvement in interleukin-6 levels, or other blood measures of inflammation, immune activation, fibrosis activity or myocardial function. CD4+ and CD8+ T cells also did not differ by treatment group. Losartan reduced SBP and DBP by 6 and 5 mmHg, respectively.

Conclusion:

Among older PHIV with viral suppression, losartan did not improve blood measures of inflammation nor T-cell immune recovery. Losartan treatment is unlikely to reduce inflammation associated comorbidities to a clinically meaningful degree, beyond the benefits from lowering blood pressure.

ClinicalTrials.gov:

NCT02049307.
Interventions to improve daily medication use among adolescents and young adults: what can we learn for youth pre-exposure prophylaxis services?
Authors: Velloza Jennifer , Kapogiannis Bill , Bekker Linda-Gail , Celum Connie , Hosek Sybil , Delany-Moretlwe Sinead , Baggaley Rachel , Dalal Shona
Published: November 2020

Objective:

Oral pre-exposure prophylaxis (PrEP) is an important HIV prevention method and studies have shown that young people ages 15–24 have difficulty adhering to daily PrEP. The field of PrEP delivery for young people is relatively nascent and lessons about potential PrEP adherence interventions could be learned from the larger evidence base of adherence interventions for other daily medications among youth.

Design:

Systematic review of adherence support interventions for adolescents.

Methods:

We searched PubMed, CINAHL, EMBASE, and PsycINFO through January 2020 for oral contraceptive pill (OCP), antiretroviral therapy (ART), asthma, and diabetes medication adherence interventions. We reviewed primary articles about OCP adherence interventions and reviewed systematic reviews for ART, asthma, and diabetes medication adherence interventions. Studies were retained if they included participants’ ages 10–24 years; measured OCP, ART, asthma, or diabetes medication adherence; and were systematic reviews, randomized trials, or quasi-experimental studies.

Results:

Fifteen OCP articles and 26 ART, diabetes, and asthma systematic reviews were included. Interventions that improved medication adherence for OCPs, ART, asthma, and diabetes treatment included reminder text messages, computer-based and phone-based support, and enhanced counseling. Multi-month prescriptions and same-day pill starts also were found to improve OCP adherence and continuation. Adolescent-friendly clinics and peer-based counseling significantly improved ART adherence, and telemedicine interventions improved diabetes medication adherence.

Conclusion:

Interventions that improve medication adherence among youth include enhanced counseling, extended pill supply, adolescent-friendly services, and text message reminders. PrEP programs could incorporate and evaluate such interventions for their impact on PrEP adherence and continuation among at-risk adolescents.
Craniomaxillofacial Surgery Techniques of 15th Century Turkish Surgeon Serefeddin Sabuncuoglu
Authors: Doğan Fatih , Tutak Fatma Nilay
Published: November 2020

Introduction:

Şerefeddin Sabuncuoğlu, in his surgical medicine book entitled “Imperial Surgery” (Cerrâhiyetü’l-Hâniyye) that was published in the 15th century, described many diseases using colored miniatures, and explained the repair of these conditions using surgical methods and the required patient care after surgery. In his handwritten treatise, Sabuncuoğlu raised the curtain on his surgical methods with his illustrations. As a first in medical history, Sabuncuoğlu's book should be considered one of the most important original works from that era.

Materials and Method:

The handwritten “Imperial Surgery” is presented in three chapters divided into 194 sections, and describing 147 surgical procedures with miniature drawings, 160 surgical instruments and 10 types of incision.

Results:

A separate chapter is allocated to craniomaxillofacial surgery in Imperial Surgery, containing 53 of the total 194 sections. The first chapter describes the use of branding (cauterization) for the treatment of headache and facial diseases. The second chapter describes the treatment of hydrocephalus, headache, vascular surgery, and the surgical treatment of tumors in the head and face. The third chapter describes in detail the treatment of cranial fractures, nasal fractures, mandibular fractures and mandibular dislocations.

Conclusion:

The basic craniomaxillofacial surgery concepts, the descriptions of craniomaxillofacial diseases, the scales indicating the general patient conditions, and the surgical therapies, incisions, surgical instruments, postoperative care and complications put forward in the book are discussed in the present study. In the light of this seminal study, the authors of the present study suggest that Sabuncuoğlu should be considered and dignified as one of the leading pioneers of craniomaxillofacial surgery.
A Simple Method of Transoperative Maxillomandibular Fixation in Pediatric Facial Fractures
Authors: Rodrigues Moacyr Tadeu Vicente , Schueng Filipe E. A. , Mendes Bruno Coelho , Vale Daniel Santiago , Souza Fabrício Guimarães de , Nóia Cláudio Ferreira
Published: November 2020

Maxillomandibular fixation in pediatric facial fractures is quite challenging to be achieved, especially in mid-mixed dentition. Traditional well established intermaxillary devices have a lot of limitations in these patients. This article presents a case of a 9-year-old female patient with a displaced mandibular fracture in which orthodontic buttons were used for transoperative maxillomandibular fixation followed by internal fixation after adequate occlusion reestablishment and fracture reduction. The method showed high efficacy and celerity, allowing the success of treatment, with satisfactory evolution of the patient.
The Orthognathic Quality of Life Questionnaire: Translation and Validation into Dutch
Authors: Ploumen Roan L.M. , Duininck Jorrit M. , Jonkman Ronald E.G. , Nolte Jitske W. , Becking Alfred G.
Published: November 2020

Objective:

The aim of this study is to translate and validate the Orthognathic Quality of Life Questionnaire (OQLQ) in the Dutch language (OQLQ-NL).

Methods:

The translation of the OQLQ into the Dutch language was performed following the guidelines for the Process of Cross-Cultural Adaption of Self-Report Measures. Sixty-two patients who received orthognathic surgery in the past 10 years were included for participation. Internal reliabilities of the OQLQ-NL were evaluated for multiple item scales with the use of the Cronbach alpha coefficient. For the establishment of the test–retest reliability, the OQLQ-NL was repeated with a 2-week interval and the intraclass correlation coefficient was calculated. Spearman correlation was used to test the correlation with the OHIP-49NL and the FACE-Q, to be able to evaluate the construct validity of the OQLQ-NL.

Results:

Thirty-five patients filled in the OQLQ-NL, OHIP49NL, and FACE-Q upon arrival and 22 patients returned the OQLQ-NL after 2 weeks (response rate of 56.6% and 62.9%, respectively). The OQLQ-NL showed excellent results in internal reliability and test–retest reliability. The vast majority of the correlations between the domains of the questionnaires were as expected. Data from this study and previous studies confirm the construct validity of the OQLQ-NL

Conclusion:

The OQLQ-NL appears to be a valid and reliable instrument to measure quality of life for patients receiving orthognathic surgery in the Netherlands.
Endoscopic Endonasal Management of Pterygopalatine Fossa Tumors
Authors: Ozawa Hiroyuki , Sekimizu Mariko , Saito Shin , Nakamura Shintaro , Mikoshiba Takuya , Toda Masahiro , Ogawa Kaoru
Published: November 2020

Surgical removal of pterygopalatine fossa (PPF) tumors with endoscopic endonasal approach is still challenging. The present study aimed to evaluate our endoscopic endonasal management of PPF tumors based on the tumor pathology and purpose of the surgery. This comprised both a single nostril approach for biopsy and a binostril approach for complete resection of benign and noninfiltrating tumors. Based on this strategy, 12 patients underwent endoscopic endonasal surgery for PPF tumors between 2013 and 2018. The patients’ data were analyzed retrospectively to demonstrate the significance of our treatment scheme. The surgery was terminated only after taking a biopsy specimen in 6 patients. Other 6 patients underwent gross total resection or bulk tumor reduction. Final pathological diagnosis was malignant in 6 cases and benign in the remaining 6. Post-operative treatment was needed in 7 patients. Four operations for the 6 patients who underwent either debulking or radical surgery were performed by the binostril approach; while 5 surgeries for the 6 biopsy patients were performed by the single nostril approach. Postoperative complications were tolerable. Endoscopic resection should be adopted preferentially for benign tumors that can be removed in a piecemeal fashion. However, as most malignant tumors were impossible to resect with a negative margin, priority should be given to tumor biopsy using an endoscopic approach, which is less invasive than an open approach, and an appropriate treatment customized to the pathological diagnosis should be administered.
Application of Laparoscopic Technique in the Treatment of Hepatolithiasis
Authors: Yao Dianbo , Wu Shuodong
Published: November 2020

Hepatolithiasis is commonly encountered in Southeastern and East Asian countries, and its incidence is increasing in Western countries. For symptomatic hepatolithiasis or asymptomatic hepatolithiasis with signs of liver atrophy or malignancy, surgical intervention is needed, especially when peroral cholangioscopy and percutaneous transhepatic cholangioscopic lithotomy are not suitable or fail to be performed. Currently, laparoscopic surgery is gradually replacing traditional open surgery and becoming a better option. Various types of laparoscopic surgeries, including laparoscopic hepatectomy, laparoscopic biliary exploration through the common bile duct or the hepatic duct stump, and robotic-assisted laparoscopic surgery, have been developed for the treatment of simple hepatolithiasis, hepatolithiasis concomitant with choledocholithiasis, recurrent hepatolithiasis, and complicated hepatolithiasis. The related clinical experience is gradually accumulating. In this review, the laparoscopic applications and their advantages will be summarized. In most cases, the laparoscopic technique could provide the advantages of less trauma, reduced blood loss, and faster postoperative recovery.