bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstetric Perineal Lacerations in Women With Female Genital Mutilation (FGM) [11G]
Authors: Hickman Holly Anne , Pagidas Kelly , Gaskins Jeremy , O'Leary Katherine , Hodge Taylor
Published: October 2020

INTRODUCTION:

To evaluate whether or not women, who have undergone FGM III, have an increased rate of second degree and higher obstetric perineal lacerations than a control group of similar patients.

METHODS:

For this retrospective chart review, we searched the electronic medical record (EMR) for patients speaking Somali, Arabic, Kurdish, Swahili, and French, who delivered at the University of Louisville Hospital from April 10, 2016 through August 10, 2017. We then entered baseline characteristics and delivery details into a secure database. A total of 110 patients were included. We looked at type of FGM, mode of delivery, rates of assisted delivery and primary cesarean section, types of perineal lacerations, and whether or not defibulation was performed.

RESULTS:

The baseline characteristics had several significant differences between the controls (n=84), FGM II (n=11), and FMG III (n=15) patients. Most strikingly, the FGM III population was 93% nulliparous. We controlled for this in our analysis with logistic regression models. The odds ratios (OR) of a second degree or higher perineal laceration comparing FGM III to controls (OR 5.06, 0.87-53.84) was not significant (p=0.0687). After logistic regression was applied controlling for body mass index, nulliparity, and assisted delivery, there was no increased risk of laceration in women with FGM III (AOR 1.06, CI 0.11-10.35, p=0.9571). We found that we correctly followed the standard of care and defibulated 89% (8/9) of women with FGM III that underwent vaginal delivery.

CONCLUSION:

Women with FGM III did not appear to have an increased risk of second degree and higher perineal lacerations.
Association of Class II Obesity and Hypertension With Perinatal Outcomes in ART Conceived Twin Pregnancies [21P]
Authors: Mulhall J. Connor , Arkfeld Christopher K. , Shea Ashley , Dahlke Joshua D.
Published: October 2020

INTRODUCTION:

Obesity and hypertensive disorders (chronic hypertension, gestational hypertension, preeclampsia) have an associated increased risk of adverse perinatal outcomes in singleton and twin gestations. These associations are less defined when both occur in twin gestations conceived through artificial reproductive technology (ART). Our objective was to evaluate the impact of preconception concurrent Class II obesity (BMI ≥35 kg/m2) and hypertension on perinatal outcomes from twin gestations conceived through ART.

METHODS:

IRB approval was obtained. We performed a retrospective cohort study of twin gestations delivered at one tertiary care center and had ultrasonography in our MFM clinic between January 1, 2013 and September 1, 2017. Women with spontaneous conception, unknown contraceptive method, missing maternal/neonatal data, and monochorionic-monoamniotic twins were excluded. Our primary outcome was neonatal and maternal morbidity in twin pregnancies conceived by ART among two groups: 1) preconception BMI ≥-35 kg/m2 with a hypertensive condition and 2) preconception BMI <35 kg/m2 without hypertension.

RESULTS:

Of 587 twin pregnancies identified, 229 met inclusion criteria. 213 patients had preconception BMI <35 kg/m2 without hypertension; 16 patients had preconception BMI ≥-35 kg/m2 with a hypertensive condition. Compared to preconception BMI <35 kg/m2 without hypertension, the preconception BMI ≥35 kg/m2 with hypertension group were more likely to have a 5 minute Apgar score <5 (P=.008), intrauterine fetal demise (P=.025), maternal gestational diabetes mellitus (P=.007), and cesarean delivery (P=.003).

CONCLUSION:

ART conceived twin gestations in women with preconception Class II obesity and hypertension have an associated increased risk of 5 minute Apgar score <5, IUFD, maternal gestational diabetes, and cesarean section compared to women without these conditions.
Provider Perspectives on Sterilization: The Complexities and Challenges of Sterilization Counseling [5R]
Authors: Monaco Alexandra , Rangnekar Niyati , Hamm Megan E. , Maples Jill , Borrero Sonya , Zite Nikki B.
Published: October 2020

INTRODUCTION:

The purpose of this project was to explore provider perspectives regarding women's informational and decision support needs around sterilization decision making, the complexities and challenges of sterilization counseling, and how these factors may differ for low-income women.

METHODS:

Semi-structured, 30-45 minute telephone interviews with 15 obstetrician-gynecologists in 3 different geographic regions were audio-recorded and transcribed verbatim. A codebook was inductively developed through review of the interview transcripts, and then applied to all transcripts by two coders with the assistance of NVivo qualitative data analysis software. Coding differences were adjudicated to full agreement. This finalized coding was used to assist in a thematic analysis of the transcripts.

RESULTS:

Obstetrician-gynecologists described several challenges to providing high-quality sterilization counseling. Providers discussed inherent tensions between respecting women's reproductive autonomy and concern for future regret. Specifically, they wanted to support women's desire for sterilization but were often concerned that women did not have the information they needed or the foresight to make high-quality decisions. They identified significant barriers to counseling including lack of time in the visit, lack of continuity over the course of prenatal care, and significant baseline misinformation among patients. They also identified barriers to postpartum sterilization after a decision was made, including lack of timely OR availability and maternal factors like obesity. Providers felt that low-income women faced more challenges in sterilization decision-making, including significant baseline knowledge gaps and sterilization consent regulations required by Medicaid federally.

CONCLUSION:

Efforts are needed to support providers and women with regard to sterilization counseling and decision-making.
Unmonitored Labor Episodes in Obese Parturients With Wireless Versus Conventional Fetal Heart Rate Monitoring [16S]
Authors: Blitz Matthew J. , Sharma Ruchira , Gerber Rachel , Lal Tara N. , Rabin Jill M. , Meirowitz Natalie
Published: October 2020

INTRODUCTION:

To determine the frequency and duration of unmonitored labor (UL) episodes in obese parturients exposed to wireless fetal heart rate (FHR) monitoring compared to exclusively conventional wired FHR monitoring.

METHODS:

Retrospective cohort of obese gravidas with non-anomalous, term singleton gestations admitted for induction or early labor at a tertiary hospital. Patients were excluded for initial cervical dilation ≥5 cm or prior cesarean delivery. Groups were defined by whether any exposure to wireless FHR monitoring (Monica Novii Wireless Patch System, GE Healthcare) occurred during admission for delivery. Each subject's complete FHR tracing was reviewed. Outcomes were UL episodes/hour and minutes/hour of FHR monitoring. UL is defined as ≥2 minutes of absent or discontinuous FHR tracing, excluding intentional interruptions exceeding 30 minutes.

RESULTS:

A total of 1,350 hours of FHR monitoring were reviewed for 52 deliveries (24 wireless, 28 wired). BMI was higher in the wireless compared to the wired group (38.1 vs. 34.7 kg/m2); no other demographic differences were observed. In the wireless group, 54.2% of FHR monitoring time was wireless. No differences in UL were observed between the wireless and wired groups. However, within the wired group, which was exposed to both forms of FHR monitoring, there were fewer UL episodes/hour (0.41 vs. 0.85; P<0.005) and UL minutes/hour (2.8 vs. 7.5; P<0.001) during the wireless FHR monitoring period compared with the wired FHR monitoring period.

CONCLUSION:

Wireless FHR monitoring may reduce periods of UL, particularly in high BMI patients. Future studies should evaluate whether this affects obstetrical outcomes.
Broad Utility of a Minimally Invasive Technique for Pediatric Wound Care: Simple and Effective
Authors: Steen Emily H. , Tuley Jill M. , King Alice , Lee Timothy C. , Keswani Sundeep G.
Published: October 2020

OBJECTIVE

Infected or contaminated wound sites have historically been managed with incision and drainage. Here, the authors review their experience with skin closure over vessel loops and assess the results of this technique in a variety of clinical situations, hypothesizing that minimally invasive drainage strategies are associated with a decrease in common postoperative complications.

METHODS

Investigators retrospectively reviewed the data of all children with infected or contaminated wound sites operated on by a single surgeon with skin closure over vessel loops from September 2016 to September 2018. Demographics, indications for surgery, complications, and follow-up were assessed.

RESULTS

Over a 2-year period, 33 children underwent skin closure over vessel loops. The majority were female (82%), Hispanic/Latino (40%), and younger than 5 years (58%; range, 4 months to 16 years). One-third were obese. Reasons for intervention included skin and soft tissue infection (64%), trauma (15%), and ostomy closure (6%). Median postoperative length of stay was 1 day. Three-quarters (76%) of the patients returned to the clinic for follow-up and/or vessel loop removal. At 30 days after operation, no patients in this cohort returned to the ED with recurrent infection or wound dehiscence.

CONCLUSIONS

This minimally invasive technique for contaminated wound management demonstrates no evidence of subsequent infection in standard follow-up. These results are indicative of specific advantages related to vessel loop drainage, including shorter lengths of stay and ease of wound maintenance, in a variety of challenging clinical scenarios.
Treatment of Superficial Incision Dehiscence after Abdominal Surgery by Z-Plasty: A Retrospective Case Series
Authors: Cao Zilong , Zhang Fan , Liu Xujin , Zhang Min , Ma Yuntao
Published: October 2020

OBJECTIVE

To explore the treatment of superficial incision dehiscence after abdominal surgery by Z-plasty combined with negative-pressure wound therapy.

METHODS

A retrospective study was performed on seven patients with superficial abdominal incision dehiscence from October 2018 to February 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, surgical debridement with negative-pressure wound therapy was performed. Local Z-plasty was performed in the second stage.

RESULTS

The incision healed well in all patients, and no infection or necrosis occurred in the flaps. During the follow-up of 7.3 months (range, 5-10 months), no incision rupture or redehiscence occurred.

CONCLUSIONS

Surgical debridement, negative-pressure wound therapy, and Z-plasty can be used to treat superficial abdominal incision dehiscence and achieve good therapeutic effect and prognosis. Z-plasty can be used as an alternative to direct suture of incisions because of its simplicity and excellent results.
Efficacy of Surgical Excision and Brachytherapy in the Treatment of Keloids: A Retrospective Cohort Study
Authors: Daurade Mathieu , Breton Pierre , Rouard Nathalie , Lorchel Fabrice , Ibrahim Badr , Sigaux Nicolas
Published: October 2020

OBJECTIVE

To demonstrate the efficacy of a protocol combining surgical excision and high-dose-rate brachytherapy for treatment of keloids.

METHODS

The authors performed a unicentric retrospective cohort study between 2013 and 2018. The minimum follow-up was 12 months. All patients treated for keloids at the authors’ institution were included. Extralesional excision was performed with placement of a brachytherapy sheath under the skin. The total dose of irradiation was 18 Gy. The postoperative results were evaluated for aesthetic and functional outcomes with a validated scale, as well as the presence or absence of recurrence.

RESULTS

Fifteen patients were lost to follow-up. Thirty-eight patients with 67 keloids were included. The control rate was 94%. The aesthetic and functional outcomes were considered good in 62% of cases. The main limitation of the study was the small patient population.

CONCLUSIONS

Extralesional excision combined with postoperative high-dose-rate brachytherapy seems to be one of the most effective invasive protocols to treat and prevent keloids.
Life on Call: Perspectives of Junior and Senior Internal Medicine Residents
Authors: Cygler Jeremy , Page Andrea V. , Ginsburg Shiphra
Published: October 2020

Purpose

Models of daytime and nighttime on-call responsibilities for residents vary across internal medicine training programs, but there are few data regarding residents’ perceptions of their on-call experiences. The authors sought to understand what residents perceive as the benefits and detriments of 24-hour, in-house call, a perspective instrumental to informing change.

Method

The authors conducted in-depth individual interviews and focus groups between December 2018 and March 2019 with 17 internal medicine residents from postgraduate years 1, 2, and 3 at the University of Toronto about their on-call experiences. Using constructivist grounded theory, the authors developed a framework to understand the residents’ perceived benefits and drawbacks of 24-hour in-house call.

Results

Residents’ experiences on call were grouped into 7 themes regarding negative and positive aspects of call. Participants reported multidimensional fatigue related to call, including decision fatigue, emotional fragility and lability, and loss of empathy, and also reported that call adversely affected their personal lives. Residents expressed conflicting opinions as to whether prolonged duty hours affected patient outcomes. In contrast, residents also expressed benefits to call, including that overnight call led to increased autonomy and decision-making skills and provided preparation for future careers as independent internists. They described developing camaraderie and a sense of belonging to a team with coresidents overnight. Lastly, residents described occupying different roles during regular duty hours and while on call—daytime roles revolved around follow-up of previously admitted patients and administrative tasks, while overnight duties centered on initial workup and medical stabilization of referred patients.

Conclusions

Understanding the nuanced phenomenon of being on call from the perspective of those who live through it is a critical step in creating evidence-based educational policies. New call models should emphasize resident autonomy and decision making and should include a consideration of residents’ perceived differences between daytime and on-call roles.
A Method to Improve Continuous Renal Replacement Therapy Circuit Survival Time in Critically Ill Coronavirus Disease 2019 Patients With Acute Kidney Injury
Authors: Volbeda Meint , Londema Mark , van Meurs Matijs , Stegeman Coen A. , Gansevoort Ron T. , Berger Stefan P. , van der Voort Peter H. J. , Franssen Casper F. M.
Published: October 2020

Objectives:

Optimizing continuous renal replacement therapy circuit survival in coronavirus disease 2019 patients admitted to the ICU.

Design:

Single-center prospective observational cohort study.

Setting:

Tertiary academic teaching ICU.

Patients:

Between March 19, 2020, and May 18, 2020, 11 out of 101 coronavirus disease 2019 patients were treated with continuous renal replacement therapy comprising 127 continuous renal replacement therapy days.

Interventions:

A nonrandomized observational comparison of circuit anticoagulation modalities using standard regional citrate anticoagulation, continuous IV heparin anticoagulation, or the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin.

Measurements and Main Results:

Circuit patency was shorter than 24 hours using standard regional citrate anticoagulation or continuous IV heparin anticoagulation. Median circuit survival increased with at least 165% when the combination of regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin was applied.

Conclusions:

Continuous renal replacement therapy circuit patency is diminished in coronavirus disease 2019 ICU patients. Combining regional citrate anticoagulation with either continuous IV heparin or therapeutic dose nadroparin increases filter survival as compared with regional citrate anticoagulation alone in this nonrandomized observational study.
Multikinase inhibitors for the treatment of radioiodine refractory thyroid cancer: what have we learned from the ‘real-world’ experience?
Authors: Costante Giuseppe
Published: October 2020

Purpose of review

Several molecularly targeted drugs for treating radioiodine resistant differentiated thyroid carcinomas (RAIR-DTC) have been identified. Among these, sorafenib and lenvatinib have been approved for clinical use in many countries. The present review will analyze efficacy and safety ‘real-world’ data (RWD) emerging after their commercialization.

Recent findings

RWDs confirmed sorafenib and lenvatinib efficacy in terms of progression-free survival and, perhaps, overall survival improvement in patients with RAIR-DTC. Lenvatinib performance in RWDs appeared somehow lower than in randomized clinical trials (RCT), probably because the decision to start treatment in ‘real life’ was made when patients were in worse clinical conditions than in RCTs. Concerning safety, RWD studies corroborated RCT evidence of elevated overall and serious adverse event incidence. Notably, adverse events were manageable in most cases with appropriate treatment or dose reduction/interruption, so that the need for definitive withdrawal was limited. The suitability of multikinase inhibitors (MKI) as salvage therapy in RAIR-DTCs was also confirmed by RWD experience, at least for lenvatinib in the second-line setting.

RWD analysis has corroborated RCT results in terms of MKI efficacy for both first-line and salvage treatment in patients with RAIR-DTC. The safety profiles emerging from RWDs seem to justify the caution recommended by most scientific guidelines.
Leptin levels predict the development of left ventricular hypertrophy in a sample of adult men: the Olivetti Heart Study
Authors: D’Elia Lanfranco , Giaquinto Alfonso , de Simone Giovanni , Iacone Roberto , Russo Ornella , Strazzullo Pasquale , Galletti Ferruccio
Published: October 2020

Objective:

A higher leptin (LPT) is associated with a greater cardiometabolic risk. Some studies also showed a positive association between LPT and cardiovascular organ damage but no consistent data are available about a predictive role of LPT on cardiac remodelling. Hence, the aim of this study was to evaluate the potential role of LPT on the incidence of left ventricular hypertrophy (LVH) in a sample of adult men.

Methods:

The study population was made up of 439 individuals (age: 51 years) without LVH at baseline, participating in The Olivetti Heart Study. The ECG criteria were adopted to exclude LVH at baseline and echocardiogram criteria for diagnosis of LVH at follow-up were considered.

Results:

At baseline, LPT was significantly and positively correlated with BMI, waist circumference, ECG indices, SBP and DBP but not with age and renal function. At the end of the 8-year follow-up period, there was an incidence of 23% in LVH by echocardiography. Individuals who developed LVH had higher baseline age, LPT, BMI, waist circumference, blood pressure and ECG indices (P < 0.05). Furthermore, those that had LPT above the median had greater risk to develop LVH (odds ratio: 1.7; P < 0.05). This association was also confirmed after adjustment for main confounders, among which changes in blood pressure and anthropometric indices.

Conclusion:

The results of this study suggest a predictive role of circulating LPT levels on cardiac remodelling expressed by echocardiographic LVH, independently of body weight and blood pressure changes over the years.
Prevalence of Urinary Tract Infection in Febrile Infants With Upper Respiratory Tract Symptomatology
Authors: Bolivar Patricia , de Ponga Pilar , Granda Elena , Velasco Roberto
Published: October 2020

Among 439 infants presenting with symptoms of upper respiratory tract infection and temperature ≥39°C, 19 (4.3% [95% confidence interval, 2.8–6.7]) received a diagnosis of urinary tract infection (abnormal urine dipstick from a sterile urine sample and positive urine culture). Regardless of respiratory presentation, all infants presenting with a temperature of 39°C should be screened for urinary tract infection.
One-year performance of thin-strut cobalt chromium sirolimus-eluting stent versus thicker strut stainless steel biolimus-eluting coronary stent: a propensity-matched analysis of two international all-comers registries
Authors: Vlieger Selina , Danzi Gian B. , Kauer Floris , Oemrawsingh Rohit M. , Stojkovic Sinisa , IJsselmuiden Alexander J.J. , Routledge Helen , Laanmets Peep , Roffi Marco , Fröbert Ole , Baello Pascual , Wlodarczak Adrian , Puentes Angel , Polad Jawed , Hildick-Smith David
Published: October 2020

Objectives

Recent improvements in coronary stent design have focussed on thinner struts, different alloys and architecture, more biocompatible polymers, and shorter drug absorption times. This study evaluates safety and efficacy of a newer generation thin-strut cobalt chromium sirolimus-eluting coronary stent (SES, Ultimaster) in comparison with a second-generation thicker strut stainless steel biolimus-eluting stent (BES, Nobori) in percutaneous coronary intervention (PCI) practice.

Methods

A propensity score analysis was performed to adjust for differences in baseline characteristics of 8137 SES patients and 2738 BES patients of two PCI registries (e-Ultimaster and NOBORI 2). An independent clinical event committee adjudicated all endpoint-related adverse events.

Results

The use of SES, as compared with BES was associated with a significantly lower rate of myocardial infarction (MI) (1.2% vs 2.2%; P = 0.0006) and target vessel-related MI (1.1% vs 1.8%; P = 0.002) at 1 year. One-year composite endpoints of all predefined endpoints were lower in patients undergoing SES implantation (target lesion failure: 3.2% vs 4.1%; P = 0.03, target vessel failure: 3.7% vs 5.0%; P = 0.003, patient-oriented composite endpoint 5.7% vs 6.8%; P = 0.03). No significant differences between SES and BES were observed in all-cause death (2.0% vs 1.6%; P = 0.19), cardiac death (1.2% vs 1.2%; P = 0.76) or stent thrombosis (0.6% vs 0.8%; P = 0.43).

Conclusions

These findings suggest an improved clinical safety and efficacy of a newer generation thin-strut SES as compared with a second-generation thicker strut BES.
Outcomes in prediabetes vs. diabetes in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous intervention
Authors: Kim Yong Hoon , Her Ae-Young , Jeong Myung Ho , Kim Byeong-Keuk , Hong Sung-Jin , Kim Seunghwan , Ahn Chul-Min , Kim Jung-Sun , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo
Published: October 2020

Objective

The comparative long-term clinical outcomes between patients with prediabetes and diabetes in patients with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) who were undergoing percutaneous coronary intervention (PCI) are not well known. We therefore compared the 2-year clinical outcomes in such patients.

Methods

A total of 2963 patients with NSTEMI and MVD [normoglycemia (group A, n = 629), prediabetes (group B, n = 802), and diabetes (group C, n = 1532)] were evaluated. The primary outcomes were the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization. The secondary outcome was stent thrombosis.

Results

The cumulative incidence of MACE as well as for death or MI in group B and C were similar when compared to each other. However, they (P = 0.048 and P = 0.017, respectively and P = 0.022 and P = 0.001, respectively) were significantly higher than in group A. The cumulative incidence of all-cause death in group B (P = 0.042) and all-cause death and cardiac death in group C (P = 0.001 and P = 0.028, respectively) were significantly higher than in group A. However, those of all-cause death, cardiac death, Re-MI, any repeat revascularization, and ST were not significantly different between groups B and C.

Conclusion

In this study, patients with NSTEMI and MVD who underwent successful implantation of newer-generation DES and were prediabetic had worse outcomes compared to normoglycemics and comparable to those with diabetes.
Allergen bronchoprovocation test: an important research tool supporting precision medicine
Authors: Boulet Louis-Philippe , Côté Andréanne , Abd-Elaziz Khalid , Gauvreau Gail , Diamant Zuzana
Published: October 2020

Purpose of review

Allergen bronchoprovocation test (ABT) has been used to study asthma pathophysiology and as a disease-modelling tool to assess the properties and efficacy of new asthma drugs. In view of the complexity and heterogeneity of asthma, which has driven the definition of several phenotypes and endotypes, we aim to discuss the role of ABT in the era of precision medicine and provide guidance for clinicians how to interpret and use available data to understand the implications for the benefits of asthma treatment.

Recent findings

In this review, we summarize background knowledge and applications of ABT and provide an update with recent publications on this topic. In the past years, several studies have been published on ABT in combination with non-invasive and invasive airway samplings and innovative detection techniques allowing to study several inflammatory mechanisms linked to Th2-pathway and allergen-induced pathophysiology throughout the airways.

ABT is a valuable research tool, which has strongly contributed to precision medicine by helping to define allergen-triggered key inflammatory pathways and airway pathophysiology, and thus helped to shape our understanding of allergen-driven asthma phenotypes and endotypes. In addition, ABT has been instrumental to assess the interactions and effects of new-targeted asthma treatments along these pathways.
Is there a role of penicillin allergy in developing Clostridioides difficile infection?
Authors: Schwiebert Ralph , Sandoe Jonathan
Published: October 2020

Purpose of review

To explore the evidence for an association between penicillin allergy, antibiotic prescribing and Clostridioides difficile (CDI) infection.

Recent findings

Several studies have highlighted the differences in antibiotic prescribing in penicillin allergic patients and the impact on rates of C. difficile infection.

Penicillin allergy leads to higher incidences of prescriptions for antibiotics that are known to predispose to CDI. In turn CDI is more common in patients with penicillin allergy. Penicillin allergy is often erroneously ascribed to patients and should be challenged.
An update on international practice variation in peanut introduction: conundrums, controversies, and a new direction
Authors: Yuan Irene , Greenhawt Matthew , Shaker Marcus
Published: October 2020

Purpose of review

Introduction of peanut during the first year of life is associated with an 81% relative risk reduction of developing peanut allergy in infants with severe eczema, egg allergy, or both. However, significant international variation exists in risk stratification prior to peanut introduction.

Recent findings

A policy-level screening approach, such as the one in the United States, is not practical and is associated with higher costs and more cases of peanut allergy over time, in contrast to international models that recommend universal early introduction without prescreening. In Australia, population-level efforts to introduce peanut early without screening have demonstrated high rates of peanut introduction before 12 months of age and low rates of severe allergic reactions. In contrast, screening prior to peanut introduction in the United States is associated with ‘screening creep’ – the tendency of clinicians to test populations where screening is not recommended.

Early peanut introduction can reduce the risk of developing food allergy and is more effective without a risk-based screening approach. In some circumstances, shared clinical decision-making can facilitate food allergy prevention in a manner consistent with family values and preferences.
Human immunodeficiency virus from life taking to life giving: expanding the donor pool by using HIV-positive donors
Authors: Mehta Shikha , Locke Jayme E.
Published: October 2020

Purpose of review

We report the risks and benefits of utilizing HIV-positive organ donors.

Recent findings

The utilization of HIV-positive organs came with significant concerns including poor organ quality, increased risk of rejection, HIV disease progression, transmission of varying HIV strains and opportunistic infections, virologic failure due to antiretroviral resistance, increased risk for posttransplant malignancy, and recurrent HIV-associated nephropathy. Recently published data have shown, however, that despite the above mentioned risks, patient survival, and graft survival in persons living with HIV (PLWH) who received a kidney transplant from a HIV-positive donor (D+/R+) is similar to a kidney transplant from a HIV-negative donor (D−/R+).

To date, 268 PLWH have received an organ from a HIV-positive donor, including 198 kidney transplants and 70 liver/liver–kidney transplants. The utilization of HIV-positive donor organs has proven to be a safe and feasible approach to expanding the donor pool and improving access to lifesaving therapy for PLWH with end-stage organ disease.
Posterior Reversible Encephalopathy Syndrome in Childhood Hematological/Oncological Diseases: Multicenter Results
Authors: Bilir Özlem A. , Dikme Gürcan , Malbora Bariş , Evim Melike S. , Siviş Zühal Ö. , Tüfekçi Özlem , Bahadir Ayşenur , Karaman Serap , Vural Sema , Bayhan Turan , Yarali Hüsniye N. , Celkan Tiraje , Özbek Namik Y.
Published: October 2020

The aim of the study was to analyze the characteristics of posterior reversible encephalopathy syndrome (PRES) cases treated at 10 different institutions in our country. Fifty-eight patients diagnosed with PRES were included in this study. The data of PRES cases from 10 departments of pediatric hematology/oncology were analyzed. The mean age of the patients at the time of diagnosis of PRES was 8.95±3.66 years. Most patients (80.4%) had a primary diagnosis of acute leukemia. Patients received chemotherapy (71.4%) and/or used steroids within 14 days before the diagnosis of PRES (85.7%). Hypertension was found in 83.9% of the patients. Twenty-six patients had infections and 22 of them had febrile neutropenia. The most common electrolyte disorders were hypocalcemia, hypomagnesemia, and hypopotassemia. Six patients had tumor lysis syndrome and 4 had inappropriate antidiuretic hormone syndrome. Magnetic resonance imaging was used for diagnosis in all patients. The most commonly involved regions by magnetic resonance imaging were occipital (58%), parietal (51%), and frontal lobes (45%), respectively. Twenty-five patients required intensive care and 7 patients were intubated. In conclusion, PRES may develop during the follow-up and treatment of hematological diseases. In addition to steroid and intense combined chemotherapies, immunosuppressive agents and hypertension are also factors that may be responsible for PRES.
Development and Validation of a Model to Predict Pediatric Septic Shock Using Data Known 2 Hours After Hospital Arrival
Authors: Scott Halden F. , Colborn Kathryn L. , Sevick Carter J. , Bajaj Lalit , Deakyne Davies Sara J. , Fairclough Diane , Kissoon Niranjan , Kempe Allison
Published: October 2020

Objectives:

To use electronic health record data from the first 2 hours of care to derive and validate a model to predict hypotensive septic shock in children with infection.

Design:

Derivation-validation study using an existing registry.

Setting:

Six emergency care sites within a regional pediatric healthcare system. Three datasets of unique visits were designated:

Patients:

Patients in whom clinicians were concerned about serious infection from 60 days to 18 years were included; those with septic shock in the first 2 hours were excluded. There were 2,318 included visits; 197 developed septic shock (8.5%).

Interventions:

Lasso with 10-fold cross-validation was used for variable selection; logistic regression was then used to construct a model from those variables in the training set. Variables were derived from electronic health record data known in the first 2 hours, including vital signs, medical history, demographics, and laboratory information. Test characteristics at two thresholds were evaluated: 1) optimizing sensitivity and specificity and 2) set to 90% sensitivity.

Measurements and Main Results:

Septic shock was defined as systolic hypotension and vasoactive use or greater than or equal to 30 mL/kg isotonic crystalloid administration in the first 24 hours. A model was created using 20 predictors, with an area under the receiver operating curve in the training set of 0.85 (0.82–0.88); 0.83 (0.78–0.89) in the temporal test set and 0.83 (0.60–1.00) in the geographic test set. Sensitivity and specificity varied based on cutpoint; when sensitivity in the training set was set to 90% (83–94%), specificity was 62% (60–65%).

Conclusions:

This model predicted risk of septic shock in children with suspected infection 2 hours after arrival, a critical timepoint for emergent treatment and transfer decisions. Varied cutpoints could be used to customize sensitivity to clinical context.
Point-of-Care Influenza Testing in the Pediatric Emergency Department
Authors: Patel Prina , Laurich Vincent Matt , Smith Sharon , Sturm Jesse
Published: October 2020

Objectives

To see what the impact of introducing a rapid polymerase chain reaction–based influenza test has on length of stay (LOS) in emergency department, use of imaging, serum or urine testing, antibiotic use, and antiviral use.

Methods

Audit of electronic medical health records was performed for all emergency department visits from 2014 to 2018 between November and March, which was defined as peak flu season. Patients were included if they were between 3 months and 18 years of age, presented during peak flu season, and were tested for influenza. The pre–point of care (POC) period was defined as November through March of 2014 to 2017 which was compared with the post-POC group which was defined as November through March of 2017 to 2018.

Results

Patients tested for influenza in the pre-POC period were more likely to have complete blood count testing (44.7% vs 25.6% P < 0.01), more likely to have blood cultures performed (30% vs 16.3%, P < 0.01), more likely to have urine testing performed (21.5% vs 12.2%, P < 0.01), and more likely to have a chest radiograph completed (47.5% vs 34.4%, P < 0.01). There was no significant difference in rates of antibiotics used. There was increased rates of oseltamivir used in the post-POC period (21.2% vs 13.3%, P < 0.05. The median LOS decreased from 239 minutes in the pre-POC period to 232 minutes in the post-POC period (P < 0.05).

Conclusions

With the introduction of a polymerase chain reaction–based point-of-care influenza test, there were overall decreased rates of invasive blood work, urine studies, and imaging, and median LOS. There was also increased antiviral administration.
False-Positive 18F-PSMA-1007 and True-Negative 18F-Fluorocholine PET/CT Splenic Hemangioma
Authors: Panagiotidis Emmanouil , Paschali Anna , Xourgia Xanthi , Chatzipavlidou Vassiliki
Published: October 2020

A 62-year-old man with prostate cancer underwent both 18F-PSMA-1007 and 18F-fluorocholine PET/CT studies for biochemical recurrence. 18F-PSMA-1007 PET/CT outperformed 18F-fluorocholine PET/CT in detecting lymph node metastases in the pelvis and retroperitoneum, whereas the former showed a focus of increased uptake in the spleen not seen on 18F-fluorocholine. The 18F-PSMA-1007 –avid lesion corresponded to a splenic hemangioma, which was initially detected in an MRI scan 10 years ago, unchanged in size. This case shows different features of 18F-PSMA-1007 and 18F-fluorocholine uptake, in an incidentally detected splenic hemangioma, alerting PET/CT reports for possible pitfall.
Pressure Injury Prevention and Wound Management for the Patient Who Is Actively Dying
Authors: Vickery Jessica , Compton Lauren , Allard Jackie , Beeson Terrie , Howard Joycelyn , Pittman Joyce
Published: October 2020

Preventing pressure injuries and wound deterioration can be challenging for the patient at the end of life. Pressure injuries are often deemed unavoidable when a patient is actively dying; however, the time frame for this process is variable. As the skin fails in an actively dying patient, interventions should align with the patient and family's goals. This integrative literature review defines essential concepts to pressure injury and wound management during this final stage of life including (1) actively dying, (2) end of life, (3) palliative care, and (4) comfort measures. We also provide clinically relevant, evidence-based recommendations for pressure injury prevention and wound management of the patient who is actively dying.
On the faithfulness of molecular mechanics representations of proteins towards quantum-mechanical energy surfaces
Authors: König Gerhard , Riniker Sereina
Published: October 2020

Force fields based on molecular mechanics (MM) are the main computational tool to study the relationship between protein structure and function at the molecular level. To validate the quality of such force fields, high-level quantum-mechanical (QM) data are employed to test their capability to reproduce the features of all major conformational substates of a series of blocked amino acids. The phase-space overlap between MM and QM is quantified in terms of the average structural reorganization energies over all energy minima. Here, the structural reorganization energy is the MM potential-energy difference between the structure of the respective QM energy minimum and the structure of the closest MM energy minimum. Thus, it serves as a measure for the relative probability of visiting the QM minimum during an MM simulation. We evaluate variants of the AMBER, CHARMM, GROMOS and OPLS biomolecular force fields. In addition, the two blocked amino acids alanine and serine are used to demonstrate the dependence of the measured agreement on the QM method, the phase, and the conformational preferences. Blocked serine serves as an example to discuss possible improvements of the force fields, such as including polarization with Drude particles, or using tailored force fields. The results show that none of the evaluated force fields satisfactorily reproduces all energy minima. By decomposing the average structural reorganization energies in terms of individual energy terms, we can further assess the individual weaknesses of the parametrization strategies of each force field. The dominant problem for most force fields appears to be the van der Waals parameters, followed to a lesser degree by dihedral and bonded terms. Our results show that performing a simple QM energy optimization from an MM-optimized structure can be a first test of the validity of a force field for a particular target molecule.
Hit-to-lead and lead optimization binding free energy calculations for G protein-coupled receptors
Authors: Wan Shunzhou , Potterton Andrew , Husseini Fouad S. , Wright David W. , Heifetz Alexander , Malawski Maciej , Townsend-Nicholson Andrea , Coveney Peter V.
Published: October 2020

We apply the hit-to-lead ESMACS (enhanced sampling of molecular dynamics with approximation of continuum solvent) and lead-optimization TIES (thermodynamic integration with enhanced sampling) methods to compute the binding free energies of a series of ligands at the A1and A2Aadenosine receptors, members of a subclass of the GPCR (G protein-coupled receptor) superfamily. Our predicted binding free energies, calculated using ESMACS, show a good correlation with previously reported experimental values of the ligands studied. Relative binding free energies, calculated using TIES, accurately predict experimentally determined values within a mean absolute error of approximately 1 kcal mol−1. Our methodology may be applied widely within the GPCR superfamily and to other small molecule–receptor protein systems.
Large-scale binding affinity calculations on commodity compute clouds
Authors: Zasada S. J. , Wright D. W. , Coveney P. V.
Published: October 2020

In recent years, it has become possible to calculate binding affinities of compounds bound to proteins via rapid, accurate, precise and reproducible free energy calculations. This is imperative in drug discovery as well as personalized medicine. This approach is based on molecular dynamics (MD) simulations and draws on sequence and structural information of the protein and compound concerned. Free energies are determined by ensemble averages of many MD replicas, each of which requires hundreds of cores and/or GPU accelerators, which are now available on commodity cloud computing platforms; there are also requirements for initial model building and subsequent data analysis stages. To automate the process, we have developed a workflow known as the binding affinity calculator. In this paper, we focus on the software infrastructure and interfaces that we have developed to automate the overall workflow and execute it on commodity cloud platforms, in order to reliably predict their binding affinities on time scales relevant to the domains of application, and illustrate its application to two free energy methods.
How quickly can we predict trimethoprim resistance using alchemical free energy methods?
Authors: Fowler Philip W.
Published: October 2020

The emergence of antimicrobial resistance threatens modern medicine and necessitates more personalized treatment of bacterial infections. Sequencing the whole genome of the pathogen(s) in a clinical sample offers one way to improve clinical microbiology diagnostic services, and has already been adopted for tuberculosis in some countries. A key weakness of a genetics clinical microbiology is it cannot return a result for rare or novel genetic variants and therefore predictive methods are required. Non-synonymous mutations in the
S. aureus
dfrB
gene can be successfully classified as either conferring resistance (or not) by calculating their effect on the binding free energy of the antibiotic, trimethoprim. The underlying approach, alchemical free energy methods, requires large numbers of molecular dynamics simulations to be run. We show that a large number (
N
= 15) of binding free energies calculated from a series of very short (50 ps) molecular dynamics simulations are able to satisfactorily classify all seven mutations in our clinically derived testset. A result for a single mutation could therefore be returned in less than an hour, thereby demonstrating that this or similar methods are now sufficiently fast and reproducible for clinical use.
Chromobacterium paludis sp. nov., a novel bacterium isolated from a Chesapeake Bay marsh
Authors: Blackburn Michael B. , Farrar Jr. Robert R. , Sparks Michael E. , Kuhar Daniel , Mowery Joseph D. , Mitchell Ashaki , Gundersen-Rindal Dawn E.
Published: October 2020

Two isolates of Gram-reaction-negative, motile, violet-pigmented bacteria were isolated from a small pool in marshland near the mouth of the Nanticoke River in Maryland, USA. The isolates IIBBL 257-1T and IIBBL 257-2 had identical 16S rRNA gene sequences as determined by PCR, and highly similar fatty acid and biochemical profiles. The 16S rRNA gene sequences indicated the isolates belonged to the genus

Chromobacterium

. Genomic sequencing of IIBBL 257-1T revealed a genome of 4.27 Mb, with a G+C content of 63.6 %. Whole genome comparisons with other members of the

Chromobacterium

using JSpecies and the genome blast distance phylogeny approach indicated that among described species, IIBBL 257-1T was most closely related to

C. amazonense

and

C. phragmitis

. Comparison of the IIBBL 257-1T genome with those of type strains of these species resulted in ANIb and dDDH values of ca. 85 and 30 %, respectively, for both. These results demonstrate that IIBBL 257-1T and IIBBL 257–2 represent a new taxon within the genus

Chromobacterium

. We propose the name Chromobacterium paludis sp. nov. for this taxon; the type strain is IIBBL 257-1T (=NRRL B-65555T=JCM 33770T).
Pseudooceanicola aestuarii sp. nov., isolated from the Jiulong River Estuary in PR China
Authors: Li Yanyan , Wang Yu , Wang Yina , Lin Fang , Zhu Hongmei , Lai Qiliang , Shao Zongze , Zhou Hantao
Published: October 2020

A novel Gram-stain-negative, rod-shaped, aerobic, oxidase-positive and catalase-positive bacterium of the genus

Pseudooceanicola

, designated strain E2-1T, was isolated from surface water of Jiulong River Estuary, PR China. Cells of strain E2-1T grew in medium containing 0.5–12 % NaCl (w/v; optimum, 2–4 %), at 15–45 °C (optimum, 28–33 °C) and at pH 7.0–9.0 (optimum, pH 7.0–8.0). Comparative analyses of the 16S rRNA gene sequence revealed that strain E2-1T had the highest similarity to

Pseudooceanicola nitratireducens

JLT1210T (97.3 %) and

Pseudooceanicola batsensis

HTCC2597T (97.1 %), and had less than 97.0 % 16S rRNA gene sequence similarity to other type strains within the genus

Pseudooceanicola

. The DNA G+C content of strain E2-1T was 65.7 mol%. The average nucleotide identity and digital DNA–DNA hybridization relatedness values between E2-1T and related type strains were 75.0 and 20.1 % with

P. nitratireducens

JLT1210T and 75.6 and 20.4 % with

P. batsensis

HTCC2597T, respectively. The sole isoprenoid quinone was Q-10; the predominant polar lipids were diphosphatidylglycerol, phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, three unidentified phospholipids and six unidentified lipids; the major cellular fatty acids were C16 : 0 (17.5 %), C19 : 0 cyclo ω8c (22.7 %) and summed feature 8 (C18 : 1
 ω7c/C18 : 1
 ω6c; 10.1 %). According to the phylogenetic and genotypic results, strain E2-1T represents a novel species in the genus

Pseudooceanicola

, for which the name Pseudooceanicola aestuarii sp. nov. is proposed. The type strain is E2-1T (=MCCC 1K03742T=KCTC 72107T).
IgM autoantibodies recognizing ACE2 are associated with severe COVID-19
Authors: Casciola-Rosen Livia , Thiemann David R. , Andrade Felipe , Trejo Zambrano Maria Isabel , Hooper Jody E. , Leonard Elissa K. , Spangler Jamie B. , Cox Andrea L. , Machamer Carolyn E. , Sauer Lauren , Laeyendecker Oliver , Garibaldi Brian T. , Ray Stuart C. , Mecoli Christopher A. , Christopher-Stine Lisa , Gutierrez-Alamillo Laura , Yang Qingyuan , Hines David , Clarke William A. , Rothman Richard , Pekosz Andrew , Fenstermacher Katherine J. , Wang Zitong , Zeger Scott L. , Rosen Antony
Published: October 2020

SARS-CoV-2 infection induces severe disease in a subpopulation of patients, but the underlying mechanisms remain unclear. We demonstrate robust IgM autoantibodies that recognize angiotensin converting enzyme-2 (ACE2) in 18/66 (27%) patients with severe COVID-19, which are rare (2/52; 3.8%) in hospitalized patients who are not ventilated. The antibodies do not undergo class-switching to IgG, suggesting a T-independent antibody response. Purified IgM from anti-ACE2 patients activates complement. Pathological analysis of lung obtained at autopsy shows endothelial cell staining for IgM in blood vessels in some patients. We propose that vascular endothelial ACE2 expression focuses the pathogenic effects of these autoantibodies on blood vessels, and contributes to the angiocentric pathology observed in some severe COVID-19 patients. These findings may have predictive and therapeutic implications.

One-sentence summary

ACE2 autoantibodies in severe COVID-19 have features of a T-independent immune response, and may mediate vascular damage.