bluuebunny/crossref_metadata_2025 huggingface dataset:
An Unusual Presentation of Sacrococcygeal Germ Cell Tumor With Autoimmune Hemolytic Anemia as a Paraneoplastic Syndrome
Authors: Maddileti Varunkumar , Gazula Suhasini , Dantala Praveena
Published: September 2021

The tumors that induce autoimmune hemolytic anemia (AIHA) are usually hematological neoplasms such as malignant lymphoma and chronic lymphocytic leukemia. AIHA associated with germ cell tumors is very rare with literature limited to case reports with most of them reported with ovarian dermoid, which abated with the removal of the tumor. We report an unusual presentation of AIHA with malignant sacrococcygeal germ cell tumor in a 3-year-old child, which rapidly disappeared after the excision of a sacrococcygeal teratoma.
Secretory Carcinoma of the Salivary Gland: A Rarity in Children
Authors: Kelly Gillean A. , Venkatramani Rajkumar , Quintanilla Norma M. , Chelius Daniel C. , Roy Angshumoy , Mahajan Priya
Published: September 2021

Originally described as mammary analog secretory carcinoma (SC), SC of the salivary gland is a rare malignancy with morphologic and molecular similarities to SC of the breast. We present 2 children with salivary gland SC with the classic ETV6-NTRK3 gene fusion, including 1 with lymph node metastases. Both patients underwent surgical resection and were in remission 24 months postsurgery. One patient was additionally found to have synchronous papillary thyroid carcinoma with a TFG-MET fusion. A review of published cases highlights the expanding molecular profile and confirms the favorable course of salivary gland SC after surgical resection.
Bortezomib-based Anthracycline-free Induction for Pediatric Relapsed ALL as a Bridge to Immunotherapy
Authors: Dadi Gal , Jacoby Elad , Toren Amos , Bielorai Bella
Published: September 2021

Background:

Immunotherapy may lead to durable remissions in patients with relapsed and refractory acute lymphoblastic leukemia (R/R ALL). Patients receiving immunotherapy with a lower disease burden tend to have improved long-term outcomes and less toxicity. Thus, an induction protocol to achieve lower disease burden is required. Bortezomib added to a 4-drug induction was shown to lead to high rates of remission in R/R ALL patients. Inclusion of anthracyclines in this protocol may preclude most patients, having maximized the cumulative dose of anthracyclines. Thus, our goal was to evaluate anthracycline-free bortezomib-based induction for patients with R/R ALL.

Procedure:

We conducted a retrospective analysis of patients treated with bortezomib-based protocols for R/R ALL between 2011 and 2019 at our center. Data regarding toxicity and response rate was collected and analyzed.

Results:

Eighteen children with R/R ALL were treated with bortezomib-based induction, 13 of them without anthracyclines. Eleven patients did not complete the induction course: 6 due to toxicity, and 5 due to physician decision to proceed to immunotherapy early. Two events of treatment-related mortality occurred. There was no significant difference in toxicity between patients who treated with anthracycline and those who were not. Ten patients achieved complete remission, with 4 patients having polymerase-chain-reaction minimal residual disease below 10−4. Fifteen patients proceeded directly to immunotherapy: 11 patients received CD19 chimeric-antigen receptor-T-cells, 2 blinatumomab and 2 hematopoietic stem cell transplant.

Conclusion:

Anthracyclines can be safely omitted from bortezomib-based therapies in patients with R/R ALL, when planning to proceed to immunotherapy.
Impact of Paired Central and Peripheral Blood Cultures in Children With Cancer
Authors: Burcham Megan D. , Cochrane Anneli R. , Wood James B. , Mueller Emily L.
Published: September 2021

Children with cancer require central venous access which carries risk for line-related infections. The necessity of peripheral and central blood cultures is debated for those with fevers. We evaluated and described results for first episode of paired blood cultures from children with cancer who have a central venous line using retrospective database. Blood culture results, laboratory data, and medical outcomes were included. Descriptive analyses of blood culture results and clinical data were performed. There were 190 episodes of paired positive blood cultures with 167 true positive episodes. Of the true positive episodes, 104 (62.3%) were positive in both central and peripheral cultures, 42 (25.1%) were positive in central only cultures, and 21 (12.6%) were positive in peripheral cultures only. Intensive care unit admission within 48 hours after blood cultures (n=33) differed significantly: 28.7% for both central and peripheral, 10% for central only, and 0% for peripheral only (P=0.009). Central line removal (n=34) differed by type of positivity but was not significant: 22.1% for both central and peripheral, 23.8% for central only, and 4.8% for peripheral only (P=0.15). Peripheral blood cultures provided important medical information yet had differences in short-term clinical outcomes. Further evaluation of medical decision making is warranted.
A Case Series of Kawasaki Disease in Children With Sickle Cell Disease
Authors: Towerman Alison S. , Reich Patrick J. , Hulbert Monica L.
Published: September 2021

Prompt recognition and treatment of presumed bacterial infection in febrile children with sickle cell disease is necessary due to splenic dysfunction and impaired immune response. However, fever may be a manifestation of a noninfectious process, and health care providers must consider alternative sources. We describe 2 cases of children with sickle cell disease and persistent fevers, ultimately diagnosed with Kawasaki disease. These cases provide examples of an acute febrile illness that could lead to serious consequences if differential diagnoses are not considered and treatment is delayed.
Reliability and validity of the modified Walking and Remembering Test in persons with multiple sclerosis
Authors: Brusola Gregory A. , Mitchell Katy , Ellison Jennifer , Gleeson Peggy
Published: September 2021

Cognitive dysfunction can adversely impact the walking ability of people with multiple sclerosis. However, valid and reliable standardized clinical tools to measure cognitive-motor interference or dual-tasking in people with multiple sclerosis remain lacking. This study evaluated the validity and reliability of the modified Walking and Remembering Test (mWART) in people with multiple sclerosis. Eleven adults (mean ± SD age, 51.1 ± 13.4 years) with multiple sclerosis (Expanded Disability Status Score, 2.0–6.0) and six adults (mean ± SD age, 41.5 ± 17.2 years) without multiple sclerosis were administered the mWART twice over a 2-week period. Participants were tested on gait and digit span length under single-task and dual-task conditions according to the mWART procedures over a 10-m walkway. intraclass correlation coefficient2,k
were 0.961 for single-task gait velocity (P < 0.001), 0.968 for dual-task gait velocity (P < 0.001), 0.829 for single-task digit span (P = 0.004), and 0.439 for dual-task digit span (P = 0.154). Single-task gait velocity (P = 0.001) and dual-task gait velocity (P = 0.002) were able to discriminate between groups but dual-task costs were similar between participants with and without multiple sclerosis. Those with severe disability demonstrated the greater dual-task cost of gait velocity (P = 0.030). This study provides preliminary evidence of the mWART’s validity and reliability in measuring dual-task performance in patients with multiple sclerosis with mild to severe disability. More research is required in more heterogeneous samples of persons with multiple sclerosis.
Botulinum toxin type A therapy for bilateral focal neuropathic pruritus in multiple sclerosis: a case report
Authors: Portugal Diogo M. , Ferreira Eduardo F. , Camões-Barbosa Alexandre
Published: September 2021

Neuropathic pruritus is a form of chronic itch that occurs in the presence of direct damage to the nervous system. It tends to be severe, disabling, and difficult to treat. Usual antipruritic medications are largely ineffective and there is no consensus regarding the treatment approach. The authors report a case of a 58-year-old man with primary progressive multiple sclerosis and a history of unsatisfactory management of severe bilateral focal pruritus. Significant symptom relief was attained after local intradermal injections of botulinum toxin type A.
Examining the Experiences and Support Needs of Bereaved Parents After the Death of a Child During Early Adulthood From Cancer
Authors: Law Kate , Kirk Susan
Published: September 2021

Background

Parents experience unique grief, which may be experienced differently by mothers and fathers. A lack of knowledge about the particular bereavement experiences of the parents of young adults exists.

Objective

The aim of this study was to investigate experiences and support needs of parents after the death of a child (aged 16-29 years) from cancer, exploring changes over time.

Methods

The study used a Charmazian constructivist grounded theory approach. Semistructured interviews were conducted with 11 parents (7 mothers and 4 fathers) purposefully sampled and bereaved between 15 months and 7 years. Data were analyzed inductively using the constant comparative approach for category development.

Results

“Living with continual loss” emerged as the core category central to parents’ experiences of bereavement. Feelings of continual loss were compounded by parents’ lack of information (“grieving in the dark”) and a perceived lack of understanding from families and friends (“grieving alone”). Parents discovered strategies to manage the feeling of loss: “changing routines,” “preserving the meaning of home,” “maintaining memories and presence,” and “sharing experiences.”

Conclusions

This is the first study focusing solely on the experiences and support needs of bereaved parents of young adults who have died of cancer. Parents live with a continual sense of loss irrespective of the length of bereavement, and a lack of bereavement information and empathetic emotional support can exist.

Implications for Practice

The need for improved information giving and development of peer support for bereaved parents has been identified. Cancer centers have a continuing role in developing and providing this support.
Coping Strategies for Stress and Self-Efficacy in Patients With Cancer and Their Spouses
Authors: Amirshamsi Mohammad , Shahrbabaki Parvin Mangolian , Dehghan Mahlagha
Published: September 2021

Background

Cancer is one of the most important diseases of the present century worldwide. Patients and their spouses can find more difficulty accepting the diagnosis of cancer than its phases of treatment. Both the physical health and mental health of the patient and spouse are important in the process of recovery from cancer and its treatment.

Objective

The aim of this study was to determine the relationship between coping strategies for stress and self-efficacy in patients with cancer and that of their spouses.

Methods

In this descriptive-analytical cross-sectional study, 91 patients and their 91 spouses completed the Endler and Parker Coping Inventory, the Sherer General Self-Efficacy Scale, and a demographic information questionnaire.

Results

The problem-oriented coping style was used more than the other strategies by patients with cancer and their spouses. The least used coping style by patients and their spouses was the avoidance style. The self-efficacy of patients and their spouses was above average. Self-efficacy was directly and moderately correlated with problem-oriented coping style (P < .001) and inversely and moderately correlated with emotion-oriented coping style (P < .001).

Conclusions

Adoption of strategies like training and consulting may enhance the problem-focused coping style and reduce emotion-focused coping style and therefore lead to increased self-efficacy in patients and their spouses.

Implications for Practice

Healthcare providers’, especially nurses’, knowledge and sensitivity about the coping strategies of patients with cancer and their spouses may help providers select more effective interventions for improving patients’ and their spouses’ effective coping styles and self-efficacy.
Preparing Nursing Professional Development Practitioners for Virtual Facilitation
Authors: Reid Rachelle , Bradshaw-Scharbach Shay , DeVolt Marta , Hartly Mitch , Luttrell Julianne , Mangum-Williams Melani , Ogilvie LeAnn , Parazin Julia , Scortzaru Michelle
Published: September 2021

The COVID-19 pandemic resulted in a rapid transition from teaching in person to teaching in a virtual environment, which forced many nursing professional development practitioners unfamiliar with this methodology to quickly adapt and acquire new skills. This article describes a course created to ease nursing professional development practitioners’ transition who suddenly found themselves teaching in this unfamiliar environment. The process described may be useful for other organizations transitioning to teaching in a virtual environment.
Molecular Analysis of an Intestinal Neuroendocrine/Non-neuroendocrine Neoplasm (MiNEN) Reveals MLH1 Methylation-driven Microsatellite Instability and a Monoclonal Origin: Diagnostic and Clinical Implications
Authors: Sciammarella Concetta , Bencivenga Maria , Mafficini Andrea , Piredda Maria L. , Tsvetkova Vassilena , Paolino Gaetano , Mastrosimini Maria G. , Hetoja Selma , de Manzoni Giovanni , Mattiolo Paola , Borga Chiara , Fassan Matteo , Scarpa Aldo , Luchini Claudio , Lawlor Rita T.
Published: September 2021

Mixed neuroendocrine/non-neuroendocrine neoplasms (MiNEN) are rare mixed epithelial neoplasms in which a neuroendocrine component is combined with a non-neuroendocrine component. Here, we provide the clinical, pathologic, and molecular report of a 73-year-old-man presenting with an intestinal MiNEN. The lesion was composed of a well-differentiated G3 neuroendocrine tumor and a colloid adenocarcinoma. The molecular characterization was performed using a multigene next-generation sequencing panel. The neoplasm displayed microsatellite instability due to MLH1 promoter methylation. The extended molecular profile documented the same mutations affecting ARID1A, ASXL1, BLM, and RNF43 genes in both components, indicating a monoclonal origin of the tumor. Regarding component-specific gene mutations, BRCA2 was specifically altered in the neuroendocrine area. It may represent a new actionable target for precision oncology in MiNEN, but the lack of its alteration in the colloid component calls for further considerations on intratumor heterogeneity. The most important finding with potential immediate implications regards the presence of microsatellite instability: it indicates that this molecular alteration should become part of the diagnostic algorithm for these rare neoplasms.
Bladder Stimulation for Clean Catch Urine Collection
Authors: Ravichandran Yagnaram , Parker Sarah , Farooqi Ahmad , DeLaroche Amy
Published: September 2021

Objectives

Previous studies have demonstrated the efficacy of fluid intake with suprapubic and lumbar paravertebral massage for clean catch urine (CCU) collection in infants. We investigated the acceptability and feasibility of integrating this bladder stimulation technique (BST) into routine care in the pediatric emergency department (PED).

Methods

This was a prospective cohort study. Infants less than 6 months of age requiring a urinalysis and urine culture as part of their PED visit were recruited. All PED nurses and technicians received a standardized training outlining the BST using a video module and print materials. Success rates, bacterial contamination, parental perception of patient distress, and parent and provider satisfaction with the BST for CCU collection were compared with urethral catheterization.

Results

A total of 124 patients were recruited. The BST was successful in 38% (47/124) with a median time to void of 73 seconds (interquartile range: 19, 151). The BST was more likely to be successful in infants less than 90 days (53%; 95% confidence interval, 0.075–0.046; P = 0.005). A urinary tract infection was diagnosed in 4% of patients, with no significant differences between BST (1/47; 2%) and catheterization (4/59; 7%; P = 0.65). Patients experienced less discomfort during the BST compared with catheterization (mean numeric rating scale score, 2/10 vs 6/10; P < 0.001), and the BST was viewed positively by both parents and providers. Compared with catheterization, parents were significantly more satisfied with the BST (BST, 98%; catheterization, 58%; P < 0.001) and were more likely to consent to the BST in the future (BST, 98%; catheterization, 69%; P < 0.001). Most providers reported that the BST was well tolerated by participants (46/47; 98%), and providers felt that the BST improved parental satisfaction with the clinical encounter (46/47; 98%).

Conclusion

The BST for CCU collection is a well-tolerated and well-received approach that can easily be implemented into clinical practice with minimal training.
Who Recovers Independent Bowel Management During the First Year After a Traumatic Spinal Cord Injury?
Authors: Dionne Antoine , Mac-Thiong Jean-Marc , Lim Victor , Richard-Denis Andréane
Published: September 2021

Objectives

The aims of the study were (1) to document the characteristics of patients with impaired bowel functioning during the subacute and chronic phases and (2) to identify factors associated with recovery of independent bowel functioning during the first year after traumatic spinal cord injury in patients who present impaired bowel functioning during the subacute phase, when bowel rehabilitation is completed.

Design

This is a case-control study on 123 adult traumatic spinal cord injury patients. Bowel function assessments using item 7 of the Spinal Cord Independence Measure III were obtained 3 mos after traumatic spinal cord injury and during the early chronic phase. Univariate and multivariate analyses were conducted to identify predictors associated with recovery of independent bowel functioning between the initial assessment and follow-up.

Results

Of the 110 patients available for analysis, 54 (49%) displayed impaired bowel functioning 3 mos after traumatic spinal cord injury. Of these, 19 (35%) recovered independent bowel functioning over the following 9 mos. The total motor score was the only significant predictor of this outcome. A total motor score lower than 42 was 100% predictive of absence of recovery.

Conclusions

Recovering independent bowel management 1 yr after traumatic spinal cord injury was possible in 35% of patients despite impaired bowel functioning during the subacute phase. The total motor score measured 3 mos after injury could be useful for prognosticating potential for bowel functioning recovery because patients with total motor score lower than 42 are unlikely to recover.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Demonstrate a comprehensive understanding of the course of recovery of independent bowel function after traumatic spinal cord injury; (2) Describe the vulnerable subset of patients who present impaired bowel function at 3 mos after injury despite having received specialized bowel rehabilitation; and (3) Predict with improved accuracy the level of bowel function reached in the chronic phase for patients who present with impaired bowel function at 3 mos after injury.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Impact of Vaccination in the Rate of COVID-19 Staff Infection in an Acute Inpatient Rehabilitation Facility
Authors: Esquenazi Alberto , Watanabe Thomas , Barcikowski Jaclyn , Cao Ning , Sachinwalla Eric , Kwasniewski Michael
Published: September 2021

This brief report summarizes the comparative experience of an inpatient rehabilitation facility dealing with two episodes of COVID-19 infection, one before and one after the availability of vaccination, which was deployed to staff. The experience exemplifies the high rate of infection and potential for asymptomatic presentation of COVID-19 as well as the protective advantage of the vaccine for healthcare workers in this report. With a significant reduction in the rate of infection, from nearly 30% before vaccination to only 2.5% after vaccination. The data presented should serve as an encouragement for vaccination across all populations.
Metabolic Cost and Performance of Athletes With Lower Limb Amputation and Nonamputee Matched Controls During Running
Authors: Fischer Gabriela , Antunes Diego , Volpato Ana , Delevatti Rodrigo Sudatti
Published: September 2021

The elastic function of running-specific prostheses likely contributes to a lower metabolic cost of running. However, it remains unclear whether running-specific prostheses provide advantages concerning the metabolic cost of running in relationship with nonamputee runners. This study aimed to systematically review the scientific literature to examine the peak performance (peak oxygen consumption—VO2peak and peak speed) and the metabolic cost between paired amputees and nonamputees during running and between amputee runners with traditional prostheses and running-specific prostheses. A literature search on three databases (MEDLINE/PubMed, Scopus, and Web of Science) was conducted using the following key words: (amputation OR amputee) AND (run OR running OR runner) AND (prosthesis OR prosthetics), resulting in 2060 records and 4 studies within the inclusion criteria. A methodological quality assessment was carried out using a modified version of the Downs and Black checklist. VO2peak of the amputees athletes (54 ± 2 mL kg−1 min−1) is similar (mean difference = −0.80 mL kg−1 min−1, confidence interval = −4.63 to 3.03) to nonamputees athletes (55 ± 2 mL kg−1 min−1). The average metabolic cost of the paired amputee athletes (4.94 ± 1.19 J kg−1 m−1) also does not differ (mean difference = 0.73 J kg−1 m−1, confidence interval = −0.74 to 2.20) from nonamputee runners (4.21 ± 0.16 J kg−1 m−1). The research on running in amputee and nonamputee athletes is limited. The few existing studies have limited methodological quality. The metabolic cost data from amputee athletes running with running-specific prostheses are within the range of nonamputee data.
Learning to Kitesurf Using an Adapted Prosthesis: A Case Report
Authors: De Castro-Maqueda Guillermo , Gutiérrez-Manzanedo José V. , Minghelli Beatriz
Published: September 2021

Case description:

Kitesurfing is a sliding water sport whose popularity and number of practitioners are growing around the world. We describe an athlete of this sport who has undergone a transfemoral amputation (right leg, at the distal third), who uses a knee prosthesis that requires flexion and extension to absorb the shocks encountered. Kitesurfing under these circumstances calls for a proper prosthesis that accommodates the various strenuous maneuvers of the sport. Mr. M, 36 years old, nonprofessional athlete, uses a special prosthesis of this type.

Objective:

We report on Mr. M, a person with a transfemoral amputation, who wanted to learn to kitesurf.

Study design:

This was a case report study.

Treatment:

A prosthesis consisting of a thigh socket interface (Iceross Seal-In X TF, Iceland), knee (SymBiotechs XT9), and a foot (MotionFoot MX), which in addition to being saltwater-resistant, combines low weight and resistance to the shocks inherent to the sport.

Outcomes:

Mr. M uses this prosthesis for kitesurfing with good results in both learning and improving. During the waterstart, he must be sitting on the beach and cannot shorten his left leg. This prosthesis adjusts its tension depending on the weather and water conditions and if the subject changes sports in such a way that it should be tensioned or relaxed depending on the needs of the new sport.

Conclusions:

This prosthesis is adapted for kitesurfing and allows precise adjustments to kitesurfing maneuvers. It has allowed the user to perform the movements of the sport with success.
Predicting, Diagnosing, and Treating Acute and Early HIV Infection in a Public Sector Facility in Eswatini
Authors: Kerschberger Bernhard , Aung Aung , Mpala Qhubekani , Ntshalintshali Nombuso , Mamba Charlie , Schomaker Michael , Tombo Marie Luce , Maphalala Gugu , Sibandze Dumile , Dube Lenhle , Kashangura Rufaro , Mthethwa-Hleza Simangele , Telnov Alex , Tour Roberto de la , Gonzalez Alan , Calmy Alexandra , Ciglenecki Iza
Published: September 2021

Background:

The lack of acute and early HIV infection (AEHI) diagnosis and care contributes to high HIV incidence in resource-limited settings. We aimed to assess the yield of AEHI, predict and diagnose AEHI, and describe AEHI care outcomes in a public sector setting in Eswatini.

Setting:

This study was conducted in Nhlangano outpatient department from March 2019 to March 2020.

Methods:

Adults at risk of AEHI underwent diagnostic testing for AEHI with the quantitative Xpert HIV-1 viral load (VL) assay. AEHI was defined as the detection of HIV-1 VL on Xpert and either an HIV-seronegative or HIV-serodiscordant third-generation antibody-based rapid diagnostic test (RDT) result. First, the cross-sectional analysis obtained the yield of AEHI and established a predictor risk score for the prediction of AEHI using Lasso logistic regression. Second, diagnostic accuracy statistics described the ability of the fourth-generation antibody/p24 antigen–based Alere HIV-Combo RDT to diagnose AEHI (vs Xpert VL testing). Third, we described acute HIV infection care outcomes of AEHI-positive patients using survival analysis.

Results:

Of 795 HIV-seronegative/HIV-serodiscordant outpatients recruited, 30 (3.8%, 95% confidence interval: 2.6% to 5.3%) had AEHI. The predictor risk score contained several factors (HIV-serodiscordant RDT, women, feeling at risk of HIV, swollen glands, and fatigue) and had sensitivity and specificity of 83.3% and 65.8%, respectively, to predict AEHI. The HIV-Combo RDT had sensitivity and specificity of 86.2% and 99.9%, respectively, to diagnose AEHI. Of 30 AEHI-positive patients, the 1-month cumulative treatment initiation was 74% (95% confidence interval: 57% to 88%), and the 3-month viral suppression (<1000 copies/mL) was 87% (67% to 98%).

Conclusion:

AEHI diagnosis and care seem possible in resource-limited settings.
Multicenter Study of Outcomes Among Persons With HIV Who Presented to US Emergency Departments With Suspected SARS-CoV-2
Authors: Bennett Christopher L. , Ogele Emmanuel , Pettit Nicholas R. , Bischof Jason J. , Meng Tong , Govindarajan Prasanthi , Camargo Carlos A. , Nordenholz Kristen , Kline Jeffrey A. ,   on behalf of the RECOVER Investigators
Published: September 2021

Background:

There is a need to characterize patients with HIV with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Setting:

Multicenter registry of patients from 116 emergency departments in 27 US states.

Methods:

Planned secondary analysis of patients with suspected SARS-CoV-2, with (n = 415) and without (n = 25,306) HIV. Descriptive statistics were used to compare patient information and clinical characteristics by SARS-CoV-2 and HIV status. Unadjusted and multivariable models were used to explore factors associated with death, intubation, and hospital length of stay. Kaplan–Meier curves were used to estimate survival by SARS-CoV-2 and HIV infection status.

Results:

Patients with both SARS-CoV-2 and HIV and patients with SARS-CoV-2 but without HIV had similar admission rates (62.7% versus 58.6%, P = 0.24), hospitalization characteristics [eg, rates of admission to the intensive care unit from the emergency department (5.0% versus 6.3%, P = 0.45) and intubation (10% versus 13.3%, P = 0.17)], and rates of death (13.9% versus 15.1%, P = 0.65). They also had a similar cumulative risk of death (log-rank P = 0.72). However, patients with both HIV and SARS-CoV-2 infections compared with patients with HIV but without SAR-CoV-2 had worsened outcomes, including increased mortality (13.9% versus 5.1%, P < 0.01, log-rank P < 0.0001) and their deaths occurred sooner (median 11.5 versus 34 days, P < 0.01).

Conclusions:

Among emergency department patients with HIV, clinical outcomes associated with SARS-CoV-2 infection are not worse when compared with patients without HIV, but SARS-CoV-2 infection increased the risk of death in patients with HIV.
Pilot-Testing a Blended Learning Package for Health Care Workers to Improve Index Testing Services in Southern Malawi: An Implementation Science Study
Authors: Tembo Tapiwa A. , Simon Katherine R. , Kim Maria H. , Chikoti Chrissy , Huffstetler Hanna E. , Ahmed Saeed , Mang'anda Chimwemwe , Chu Stephen Q. , Manyeki Rachael , Kavuta Elijah , Majoni Robert , Phiri Duncan , Kalanga Alinafe , Rosenberg Nora E.
Published: September 2021

Background:

HIV index testing, an intervention in which HIV-positive “indexes” (persons diagnosed with HIV) are supported to recruit their “contacts” (sexual partners and children) efficiently identifies HIV-infected persons in need of treatment and HIV-uninfected persons in need of prevention. However, index testing implementation in sub-Saharan African health care settings has been suboptimal. The objective of this study was to develop and pilot test a blended learning capacity-building package to improve index testing implementation in Malawi.

Methods:

In 2019, a blended learning package combining digital and face-to-face training modalities was field tested at 6 health facilities in Mulanje, Malawi using a pre-/post- type II hybrid design with implementation and effectiveness outcomes. Health care worker (HCW) fidelity to the intervention was assessed via observed encounters before and after the training. Preliminary effectiveness was examined by comparing index testing program indicators in the 2 months before and 4 months after the training. Indicators included the mean number of indexes screened, contacts elicited, and contacts who received HIV testing per facility per month.

Results:

On a 30-point scale, HCW fidelity to index testing protocols improved from 6.0 pre- to 25.5 post-package implementation (P = 0.002). Index testing effectiveness indicators also increased: indexes screened (pre = 63, post = 101, P < 0.001); contacts elicited (pre = 75, post = 131, P < 0.001); and contacts who received HIV testing (pre = 27, post = 41, P = 0.014).

Conclusions:

The blended learning package improved fidelity to index testing protocols and preliminary effectiveness outcomes. This package has the potential to enhance implementation of HIV index testing approaches, a necessary step for ending the HIV epidemic.
Metal Artifact Reduction With Tin Prefiltration in Computed Tomography
Authors: Hackenbroch Carsten , Schüle Simone , Halt Daniel , Zengerle Laura , Beer Meinrad
Published: September 2021

Objectives

With the aging population and thus rising numbers of orthopedic implants (OIs), metal artifacts (MAs) increasingly pose a problem for computed tomography (CT) examinations. In the study presented here, different MA reduction techniques (iterative metal artifact reduction software [iMAR], tin prefilter technique, and dual-energy CT [DECT]) were compared.

Materials and Methods

Four human cadaver pelvises with OIs were scanned on a third-generation DECT scanner using tin prefilter (Sn), dual-energy (DE), and conventional protocols. Virtual monoenergetic CT images were generated from DE data sets. Postprocessing of CT images was performed using iMAR. Qualitative (bony structures, MA, image noise) image analysis using a 6-point Likert scale and quantitative image analysis (contrast-to-noise ratio, standard deviation of background noise) were performed by 2 observers. Statistical testing was performed using Friedman test with Nemenyi test as a post hoc test.

Results

The iMAR Sn 150 kV protocol provided the best overall assessability of bony structures and the lowest subjective image noise. The iMAR DE protocol and virtual monochromatic image (VMI) ± iMAR achieved the most effective metal artifact reduction (MAR) (P < 0.05 compared with conventional protocols). Bony structures were rated worse in VMI ± iMAR (P < 0.05) than in tin prefilter protocols ± iMAR. The DE protocol ± iMAR had the lowest contrast-to-noise ratio (P < 0.05 compared with iMAR standard) and the highest image noise (P < 0.05 compared with iMAR VMI). The iMAR reduced MA very efficiently.

Conclusions

When considering MAR and image quality, the iMAR Sn 150 kV protocol performed best overall in CT images with OI. The iMAR generated new artifacts that impaired image quality. The DECT/VMI reduced MA best, but experienced from a lack of resolution of bony fine structures.
Biomarker Analysis for Combination Therapy of Vitamin C and Thiamine in Septic Shock: A Post-Hoc Study of the ATESS Trial
Authors: Park Jong Eun , Jo You Hwan , Hwang Sung Yeon , Kim Won Young , Ryoo Seung Mok , Jang Dong-Hyun , Kim Taegyun , Kim Youn-Jung , Kim Seonwoo , Cho Hyun , Lee Gun Tak , Chung Sung Phil , Choi Sung-Hyuk , Shin Tae Gun , Suh Gil Joon
Published: September 2021

Introduction:

We evaluated the effects of vitamin C and thiamine administration on biomarkers in patients with septic shock.

Methods:

This was a post-hoc analysis of the Ascorbic Acid and Thiamine Effect in Septic Shock (ATESS) trial, a multicenter, double-blind, randomized controlled trial. Patients were randomized to either a treatment group (intravenous vitamin C and thiamine for 48 h) or a control group. Interleukin (IL)-6, IL-10, angiopoietin-II (AP2), and S100β were assessed at baseline and at 72 h. The primary outcomes were the biomarker levels at 72 h, and the secondary outcome was reduction rate.

Results:

Forty-five patients were assigned to the treatment group and 52 were assigned to the control group. Baseline biomarker levels and at 72 h were not significantly different between the treatment and the placebo groups. The reduction rates were not significantly different between the two groups. These outcome variables showed fair diagnostic accuracy for predicting 28-day mortality according to the area under the receiver operating characteristic curve.

Conclusion:

Vitamin C and thiamine administration during the early phase of septic shock did not significantly change prognostic biomarker levels of IL-6, IL-10, AP2, and S100β.

Trial registration:

NCT, ClinicalTrials.gov NCT03756220, ATESS. Registered 28 November 2018, https://clinicaltrials.gov/ct2/show/NCT03756220.
The host range restriction of bat-associated no-known-vector flaviviruses occurs post-entry
Authors: Charles Jermilia , Tangudu Chandra S. , Nunez-Avellaneda Daniel , Brault Aaron C. , Blitvich Bradley J.
Published: September 2021

Most flaviviruses are transmitted horizontally between vertebrate hosts by haematophagous arthropods. Others exhibit host ranges restricted to vertebrates or arthropods. Vertebrate-specific flaviviruses are commonly referred to as no-known-vector (NKV) flaviviruses and can be separated into bat- and rodent-associated NKV flaviviruses. Rio Bravo virus (RBV) is one of eight recognized bat-associated NKV (B-NKV) flaviviruses. Studies designed to identify the genetic determinants that condition the host range restriction of B-NKV flaviviruses have never been performed. To investigate whether the host range restriction occurs at the level of attachment or entry, chimeric flaviviruses were created by inserting the pre-membrane and envelope protein genes of RBV into the genetic backbones of yellow fever virus (YFV) and Zika virus (ZIKV), two mosquito-borne flaviviruses associated with human disease. The chimeric viruses infected both vertebrate and mosquito cells. In vertebrate cells, all viruses produced similar mean peak titres, but the chimeric viruses grew more slowly than their parental viruses during early infection. In mosquito cells, the chimeric virus of YFV and RBV grew more slowly than YFV at early post-inoculation time points, but reached a similar mean peak titre. In contrast, the chimeric virus of ZIKV and RBV produced a mean peak titre that was approximately 10-fold lower than ZIKV. The chimeric virus of YFV and RBV produced an intermediate plaque phenotype, while the chimeric virus of ZIKV and RBV produced smaller plaques than both parental viruses. To conclude, we provide evidence that the structural glycoproteins of RBV permit entry into both mosquito and vertebrate cells, indicating that the host range restriction of B-NKV flaviviruses is mediated by a post-attachment/entry event.
Sample collection and transport strategies to enhance yield, accessibility, and biosafety of COVID-19 RT-PCR testing
Authors: Banada Padmapriya , Elson David , Daivaa Naranjargal , Park Claire , Desind Samuel , Montalvan Ibsen , Kwiatkowski Robert , Chakravorty Soumitesh , Alland David , Xie Yingda L.
Published: September 2021

Introduction. Non-invasive sample collection and viral sterilizing buffers have independently enabled workflows for more widespread COVID-19 testing by reverse-transcriptase polymerase chain reaction (RT-PCR).

Gap statement. The combined use of sterilizing buffers across non-invasive sample types to optimize sensitive, accessible, and biosafe sampling methods has not been directly and systematically compared.

Aim. We aimed to evaluate diagnostic yield across different non-invasive samples with standard viral transport media (VTM) versus a sterilizing buffer eNAT- (Copan diagnostics Murrieta, CA) in a point-of-care diagnostic assay system.

Methods. We prospectively collected 84 sets of nasal swabs, oral swabs, and saliva, from 52 COVID-19 RT-PCR-confirmed patients, and nasopharyngeal (NP) swabs from 37 patients. Nasal swabs, oral swabs, and saliva were placed in either VTM or eNAT, prior to testing with the Xpert Xpress SARS-CoV-2 (Xpert). The sensitivity of each sampling strategy was compared using a composite positive standard.

Results. Swab specimens collected in eNAT showed an overall superior sensitivity compared to swabs in VTM (70 % vs 57 %, P=0.0022). Direct saliva 90.5 %, (95 % CI: 82 %, 95 %), followed by NP swabs in VTM and saliva in eNAT, was significantly more sensitive than nasal swabs in VTM (50 %, P<0.001) or eNAT (67.8 %, P=0.0012) and oral swabs in VTM (50 %, P<0.0001) or eNAT (58 %, P<0.0001). Saliva and use of eNAT buffer each increased detection of SARS-CoV-2 with the Xpert; however, no single sample matrix identified all positive cases.

Conclusion. Saliva and eNAT sterilizing buffer can enhance safe and sensitive detection of COVID-19 using point-of-care GeneXpert instruments.
Molecular characterization of rectal isolates of carbapenemase-negative carbapenem-resistant enterobacterales obtained from ICU patients in Kuwait by whole-genome sequencing
Authors: Al Fadhli Amani , Jamal Wafaa , Rotimi Vincent O.
Published: September 2021

Introduction. Carbapenem-resistant enterobacterales (CRE) are listed among the most urgent antibiotic resistance threats.

Hypothesis. Previous studies on the mechanisms of CRE in Kuwait have focused on carbapenemases. There have been no studies on non-carbapenemase-producing CRE in Kuwait.

Aim/Gap Statement. The aim of this study was to investigate the genetic characteristics of non-carbapenemase-producing carbapenem-resistant enterobacterales (NCPE) isolates using whole-genome sequencing (WGS).

Methodology. Fourteen confirmed NCPE isolates that were negative for genes encoding carbapenemase production by polymerase chain reaction (PCR) assays using rectal swabs from intensive care unit patients were characterized using phenotypic, PCR and WGS methods. Susceptibility testing was performed via Etest and clonality via multi-locus sequence typing (MLST).

Results. All of the isolates were resistant to ertapenem; 78.6 % were resistant to imipenem, meropenem and trimethoprim–sulfamethoxazole. Resistance to the other antibiotics was variable, ranging from 28.5 (colistin) through 50 (tigecycline) and 64.3 (amikacin) up to 85.7 % against both amoxicillin–clavulanic acid and ciprofloxacin. WGS detected several resistance genes mediating the production of β-lactamases, genes encoding an outer-membrane porin permeability mutation resulting in reduced susceptibility to β-lactams, including carbapenems, and genes for multidrug-resistant (MDR) efflux pumps. The isolates also possessed global activator protein MarA, which mediated reduced permeability to β-lactams. The existence of β-lactamase genes, overexpression of MDR efflux pumps and reduced permeability mediated by the porin genes were responsible for carbapenem resistance.

Conclusions. This finding reflects the superior detection capabilities offered by WGS analysis, which can be used to complement traditional methods and overcome their limited resolution in clinical settings.
Ideology, policy decision-making and environmental impact in the face of the Coronavirus pandemic in the US
Authors: Prieto-Rodríguez Juan , Salas Rafael , Noonan Douglas , Cabeza-Martinez Francisco , Ramos-Gutiérrez Javier
Published: September 2021

Covid-19 pandemic was a challenge for the health systems of many countries. It altered people’s way of life and shocked the world economy. In the United States, political ideology has clashed with the fight against the pandemic. President Trump’s denial prevailed despite the warnings from the WHO and scientists who alerted of the seriousness of the situation. Despite this, some state governments did not remain passive in the absence of federal government measures, and passed laws restricting mobility (lockdowns). Consequently, the political polarity was accentuated. On the one hand, the defenders of more severe public health measures and, on the other, the advocates of individual rights and freedom above any other consideration. In this study, we analyze whether political partisanship and the political ideology has influenced the way Covid-19 was handled at the outbreak. Specifically, we analyze by using a Diff-in-Diff model, whether the ideology of each state, measure at three levels, affected the decrease in the NO2 levels observed after the pandemic outbreak in the US. We distinguish three alternative post-Covid periods and results show that the State ideology has a robust negative impact on the NO2 levels. There is an important difference between Democratic and Republican states, not just in the scope and following-up of the mobility and activity restrictions, but also in the speed they implemented them.
Neural circuit dynamics of drug-context associative learning in the hippocampus
Authors: Sun Yanjun , Giocomo Lisa M
Published: September 2021

The environmental context associated with previous drug consumption serves as a potent trigger for relapse to drug use. The mechanism by which existing neural representations of context are modified to incorporate information associated with a given drug however, remains unknown. Using longitudinal calcium imaging in freely behaving mice, we reveal that drug-context associations for psychostimulants and opioids are encoded in a subset of hippocampal neurons. In these neurons, drug context pairing in a conditioned place preference task weakened their spatial coding for the nondrug-paired context, with drug-induced changes to spatial coding predictive of drug-seeking behavior. Furthermore, the dissociative drug ketamine blocked both the drug-induced changes to hippocampal coding and corresponding drug-seeking behavior. Together, this work reveals how drugs of abuse can alter the hippocampal circuit to encode drug-context associations and points to the hippocampus as a key node in the cognitive process of drug addiction and context-induced drug relapse.
Intersectional, anterograde transsynaptic targeting of the neurons receiving monosynaptic inputs from two upstream regions
Authors: Kitanishi Takuma , Tashiro Mariko , Kitanishi Naomi , Mizuseki Kenji
Published: September 2021

A brain region typically receives inputs from multiple upstream areas. However, currently, no method is available to selectively access neurons that receive monosynaptic inputs from two upstream regions. Here, we devised a method to genetically label such neurons in mice by combining the anterograde transsynaptic spread of adeno-associated virus serotype 1 (AAV1) with intersectional gene expression. Injections of AAV1s expressing either Cre or Flpo recombinases and the Cre/Flpo double-dependent AAV into two upstream regions and the downstream region, respectively, were used to label the postsynaptic neurons receiving inputs from the two upstream regions. We demonstrated this labelling in two distinct circuits: the retina/primary visual cortex to the superior colliculus and the bilateral motor cortex to the dorsal striatum. Systemic delivery of the intersectional AAV allowed for unbiased detection of the labelled neurons throughout the brain. This strategy may help analyse the interregional integration of information in the brain.
Rapid dynamic naturalistic monitoring of bradykinesia in Parkinson’s disease using a wrist-worn accelerometer
Authors: Habets Jeroen G.V. , Herff Christian , Kubben Pieter L. , Kuijf Mark L. , Temel Yasin , Evers Luc J.W. , Bloem Bastiaan R. , Starr Philip A. , Gilron Ro’ee , Little Simon
Published: September 2021

Introduction

Motor fluctuations in Parkinson’s disease are characterized by unpredictability in the timing and duration of dopaminergic therapeutic benefit on symptoms including bradykinesia and rigidity. These fluctuations significantly impair the quality of life of many Parkinson’s patients. However, current clinical evaluation tools are not designed for the continuous, naturalistic (real-world) symptom monitoring needed to optimize clinical therapy to treat fluctuations. Although commercially available wearable motor monitoring, used over multiple days, can augment neurological decision making, the feasibility of rapid and dynamic detection of motor fluctuations is unclear. So far, applied wearable monitoring algorithms are trained on group data. Here, we investigate the influence of individual model training on short timescale classification of naturalistic bradykinesia fluctuations in Parkinson’s patients using a single wrist-accelerometer.

Methods

As part of the Parkinson@Home study protocol, 20 Parkinson patients were recorded with bilateral wrist-accelerometers for a one hour OFF medication session and a one hour ON medication session during unconstrained activities in their own homes. Kinematic metrics were extracted from the accelerometer data from the bodyside with the largest unilateral bradykinesia fluctuations across medication states. The kinematic accelerometer features were compared over the whole one-hour recordings, and medication-state classification analyses were performed on one-minute segments of data. The influence of individual versus group model training, data window length, and total amount of training patients included in group model training on classification was analyzed.

Results

Statistically significant areas under the curves (AUCs) for medication induced bradykinesia fluctuation classification were seen in 85% of the Parkinson patients at the single minute timescale using the group models. Individually trained models performed at the same level as the group trained models (mean AUC both 0.70, +/− respectively 0.18 and 0.10) despite the small individual training dataset. AUCs of the group models improved as the length of the feature windows was increased to 300 seconds, and with additional training patient datasets.

Conclusion

Medication induced fluctuations in bradykinesia can be classified using wrist worn accelerometery at the time scale of a single minute. Rapid, naturalistic Parkinson motor monitoring has important clinical potential to evaluate dynamic symptomatic and therapeutic fluctuations and help tailor treatments on a fast timescale.