bluuebunny/crossref_metadata_2025 huggingface dataset:
Bartonella henselae Persistence within Mesenchymal Stromal Cells Enhances Endothelial Cell Activation and Infectibility That Amplifies the Angiogenic Process
Authors: Scutera Sara , Mitola Stefania , Sparti Rosaria , Salvi Valentina , Grillo Elisabetta , Piersigilli Giorgia , Bugatti Mattia , Alotto Daniela , Schioppa Tiziana , Sozzani Silvano , Musso Tiziana
Published: May 2021

Some bacterial pathogens can manipulate the angiogenic response, suppressing or inducing it for their own ends. In humans,
Bartonella henselae
is associated with cat-scratch disease and vasculoproliferative disorders such as bacillary angiomatosis and bacillary peliosis. Although endothelial cells (ECs) support the pathogenesis of
Bartonella
, the mechanisms by which
Bartonella
induces EC activation are not completely clear, as well as the possible contributions of other cells recruited at the site of infection. Mesenchymal stromal cells (MSCs) are endowed with angiogenic potential and play a dual role in infections, exerting antimicrobial properties but also acting as a shelter for pathogens.
Rapid carbohydrate fermentation test for confirmation of the pathogenic Neisseria using a Ba(OH)2 indicator
Authors: Slifkin M , Pouchet G R
Published: May 2021

The Ba(OH)2 indicator system was demonstrated to be a practical procedure in assisting clinical bacteriologists in the accurate and rapid identification of the pathogenic Neisseria from clinical specimens. This system measured the release of CO2, resulting from the metabolism of fermentable carbohydrate, as the precipitated BaCO3, by means of a spectrophotometer, The method was uncomplicated and can be performed in most clinical bacteriology laboratories.
Cardiobacterium hominis endocarditis: description of two patients and characterization of the organism
Authors: Savage D D , Kagan R L , Young N A , Horvath A E
Published: May 2021

Two cases of endocarditis caused by Cardiobacterium hominis are reported. In both instances infection was subacute and characterized by (i) implantation on abnormal valves, (ii) chronic course lasting weeks to months before recognition, and (iii) rapid clinical and bacteriological response to penicillin, as well as other antibiotics commonly used to treat infections caused by gram-negative bacilli. Our isolates of C. hominis are compared with strains in the National Institutes of Health culture collection. Optimal growth requires yeast extract and incubation at 37 degrees C with increased humidity and supplemental CO2. The production of indole, a positive oxidase reaction, and characteristic sugar fermentation distinguish C. hominis from other slow-growing, gram-negative bacilli.
Comparative serological and cutaneous reactivity of candidal cytoplasmic proteins and mannan separated by affinity for concanavalin A
Authors: Ellsworth J H , Reiss E , Bradley R L , Chmel H , Armstrong D
Published: May 2021

Yeast-form Candida albicans cells were disrupted for 1.5 min in a Braun homogenizer and centrifuged at 100,000 X g. The supernatant was concentrated by ammonium sulfate precipitation and then dialyzed. The resulting material (650 mg), containing 81.2% protein and 11.5% carbohydrate, was subjected to affinity chromatography on concanavalin A (Con A) linked to agarose. A protein fraction was eluted from the column with buffer, and a fraction containing mannan was eluted with 0.2 M alpha-methyl mannoside. The candidal soluble proteins had 19 components which were resolvable by polyacrylamide gel electrophoresis.The material with affinity for Con A contained mannan and 17% complexed protein. Antigenic differences between the soluble proteins and the mannan-protein complex were shown by lines of intersection in immunodiffusion. The soluble proteins devoid of mannan reacted in immunoelectrophoresis with sera from infected rabbits and patients with chronic candidiasis. These same sera also reacted with a mannan-protein complex eluted from the Con A column with alpha-methyl mannoside. The comparative ability of candidal proteins and cell wall-derived mannan to elicit skin test reactions in guinea pigs sensitized by infection or with formaldehyde-killed yeast was studied. Candidal proteins at a 10-mug dose elicited positive reactions at 6 and 21 days after sensitization. The reactions persisted for 48 h and showed minimal tendency to an arthus response, which was marked when mannan-containing antigens were used. The antigenicity of cell wall-derived mannans and candidal soluble proteins devoid of mannan was compared in immunodiffusion tests of sera from 39 patients with neoplastic disease. Of these patients with documented candidiasis, 13 of 20 reacted to one or more mannan antigens, and 3 of 20 reacted to candidal soluble proteins. In contrast, of those patients who were uninfected or had superficial Candida spp. infections, 5 of 19 reacted to candidal soluble proteins, and 16 of 19 reacted to one or more mannan antigens.
Further modifications of the auxanographic method for identification of yeasts
Authors: Mickelsen P A , McCarthy L R , Propst M A
Published: May 2021

A modified auxanographic carbohydrate assimilation procedure for the identification of medically important yeasts is described. This method employs a heavy inoculum of unstarved yeasts, autoclaved yeast assimilation medium, pour plates of shallow depth, and commercially available carbohydrate-impregnated disks. The accuracy of this procedure was established in a comparison with the Wickerham broth method.
Single phage-typing set for differentiating salmonellae
Authors: Gershman M
Published: May 2021

A phage-typing system is described for characterizing commonly isolated salmonellae. Fifty-eight serovars representative of groups A, B, C1, C2, D, E1, E2, E3, and E4 were delineated by using a single set of 50 phages isolated from sewage. All of the 735 cultures used in this effort were typable and were distinguished and differentiated on the basis of the 347 phage patterns observed. All results were reproducible. Characteristic phage patterns were produced by a variety of Salmonella serovars isolated from a campus incident and a number of hospital and family outbreaks to indicate an existing epidemiological relationship.
Bacteriological variation among Bordetella bronchiseptica isolates from dogs and other species
Authors: Bemis D A , Greisen H A , Appel M J
Published: May 2021

Bacteriological properties of 50 isolates of Bordetella bronchiseptica were compared. Phase variation, which involved colonial morphology and its associated characters of hemagglutination, hemolysis, acriflavine agglutination; crystal violet staining, flagellation, and fimbriation, occurred among these isolates. Organisms representing the three observed morphotypes did not have different growth rates, nor were any differences in their bacteriological characteristics observed after repeated subculture on agar. There were also variations in antimicrobial drug susceptibility, especially to sulfonamide-trimethoprim, and in nitrate reduction. The relationships among these variable parameters were not apparent. None of the observed variations could be attributed to differences in the species of origin.
Screening for cross-reacting capsular polysaccharide K antigens of Escherichia coli using antiserum agar
Authors: Counts G W , Turck M
Published: May 2021

Agar plates containing antiserum against group B meningococcus or Haemophilus influenzae type b were used to determine the prevalence of cross-reacting K1 and K100 capsular polysaccharide antigens in 265 isolates of disease-causing Escherichia coli. K1 antigen was found in 22% of isolates from various sites. K100 antigen was found in only three isolates. This technique is a convenient method to detect specific E. coli K antigens for evaluation as possible factors important in the virulence of the organism.
Template method for the fluorescent-antibody technique
Authors: Karim K A , Trust T J
Published: May 2021

An easily constructed and inexpensive template has been developed, which enables the fluorescent-antibody technique to be applied to serial dilutions and allows 18 assays on a single microscope slide.
Cellular fatty acids of Peptococcus variabilis and Peptostreptococcus anaerobius
Authors: Moss C W , Lambert M A , Lombard G L
Published: May 2021

Cellular fatty acids of Peptococcus variables and Peptostreptococcus anaerobius were identified by gas chromatography, mass spectrometry, and associated analytical techniques. Iso- and anteiso-branched-chain acids were major components in both species.
Stress-Associated Molecular and Cellular Hippocampal Mechanisms Common for Epilepsy and Comorbid Depressive Disorders
Authors: Gulyaeva Natalia V.
Published: May 2021

The review discusses molecular and cellular mechanisms common to the temporal lobe epileptogenesis/epilepsy and depressive disorders. Comorbid temporal lobe epilepsy and depression are associated with dysfunction of the hypothalamic-pituitary-adrenocortical axis. Excessive glucocorticoids disrupt the function and impair the structure of the hippocampus, a brain region key to learning, memory, and emotions. Selective vulnerability of the hippocampus to stress, mediated by the reception of glucocorticoid hormones secreted during stress, is the price of the high functional plasticity and pleiotropy of this limbic structure. Common molecular and cellular mechanisms include the dysfunction of glucocorticoid receptors, neurotransmitters, and neurotrophic factors, development of neuroinflammation, leading to neurodegeneration and loss of hippocampal neurons, as well as disturbances in neurogenesis in the subgranular neurogenic niche and formation of aberrant neural networks. These glucocorticoid-dependent processes underlie altered stress response and the development of chronic stress-induced comorbid pathologies, in particular, temporal lobe epilepsy and depressive disorders.
AB0763 IGG4-RELATED CORONARY PERIARTERITIS: SYSTEMATIC LITERATURE REVIEW WITH OUR CASE SERIES
Authors: Ito T. , Fukui S. , Kanie T. , Nakai T. , Kidoguchi G. , Ozawa H. , Kawaai S. , Ikeda Y. , Koido A. , Haji Y. , Nomura A. , Tamaki H. , Yamaguchi K. , Okada M.
Published: May 2021

Background:

Coronary periarteritis is one of the clinical manifestations of IgG4-related disease. It can cause serious conditions such as angina and ruptured aneurysms. Therefore, it is important to recognize the clinical and radiological characteristics, which was little known.

Objectives:

We report four patients with IgG4-related coronary periarteritis with a systematic literature review.

Methods:

We identified four patients with IgG4-related coronary periarteritis at the St. Luke’s International Hospital in Tokyo, Japan from 2014 to 2020. A systematic literature review was conducted for English articles on IgG4-related coronary periarteritis cases with a full text or abstract available. We summarized patient demographics, IgG and IgG4 titers, the site and morphological type of coronary lesion, and other organ involvements.

Results:

Our 4 cases and 38 cases identified by the literature review were assessed. Coronary artery lesions were detected by a coronary CT in all but two cases. Wall thickening was the most common type of the lesion. Moreover, there were 32 (76.1%) patients with other organ involvements. The commonest other lesion was peri-aortitis in 21 (50.0%) patients. In cases with peri-aortitis, IgG and IgG4 titers were significantly higher than those without peri-aortitis (IgG4; 1540 [705.0, 2570.0] vs 246.0 [160.0, 536.3]; p = 0.001, IgG; 3596.5 [2838.3, 4260.0] vs 1779.0 [1288.3, 1992.8]; p =0.040). In addition, 15 (71.4%) patients of them had three or more IgG4 related organ involvements.

Conclusion:

Coronary CT was a useful imaging modality for the diagnosis of IgG4-related coronary periarteritis, and wall thickening was the most common lesion. Moreover, about half cases coexisted with peri-aortitis. Peri-aortitis and other organ involvements should be screened in those with higher IgG and IgG4.

Table 1.

Characteristics of our cases and the literature review cases.

RCA: right coronary artery, LAD: left anterior descending artery, LCx: left circumflex artery

Disclosure of Interests:

None declared
AB0765 PHENOTYPES OF BEHCET’S DISEASE IN DIFFERENT ETHNIC GROUPS
Authors: Goloeva R. , Alekberova Z.
Published: May 2021

Background:

Early diagnosis and identification of predominant organ system involvement in Behcet’s disease (BD) is crucial for identifying most optimal treatment. The study evaluates 6 described phenotypes of BD - cutaneous-mucous, articular, ophthalmic, vascular, neurological and intestinal in different ethnic groups.

Objectives:

To assess the occurrence of Behcet’s disease (BD) phenotypes in different ethnic groups.

Methods:

The study included 202 patients with BD from the 5 most common ethnic groups.

The male-female ratio was 2.4:1. Patients’ mean age was 31 years [24;37], mean age at the disease onset was 21 years [15;28]; and mean disease duration was 7 years [3;14]. The severity of BD (mild, moderate and severe) was assessed based on the I. Krause’s Clinical Severity Scoring for BD.

Results:

Severe BD was more often diagnosed in Azerbaijanis and indigenous residents of Dagestan compared to Russians (75 and 70.4% vs. 36.2%), in Armenians - 50% and Chechens - 54.5% out of all BD cases.

Russians were significantly more likely to have a neurological phenotype (15.5% vs. 0-9.4% in all other ethnic groups) and intestinal phenotype (36.2% vs. 13.8-22.7 in all other ethnic groups). Azerbaijanis demonstrated higher prevalence of ocular involvement (68.7% versus 36.2% in Russians, 50% - in Chechens and Armenians, and 57% - in Dagestanis). Dagestanis were more likely to have a vascular phenotype (40.7% versus 15.6% in Azerbaijanis and 18.9% in Russians). The male/female ratio among Russian patients was 1:1, among Dagestanis 4.4:1, Azerbaijanis 3.5:1, Chechens and Armenians 2.6: 1.

Conclusion:

BD phenotypes vary and demonstrate significant association with the patient’s ethnic affiliation therefore, ethnicity should be viewed as the prognostic marker of specific organ-system involvement in case of a disease.

Disclosure of Interests:

None declared
AB0616 RISK FACTORS FOR PREVALENT VERTEBRAL FRAGILITY FRACTURES - STUDY IN A LONDON URBAN BOROUGH
Authors: Mothojakan N. , Zaman M. , Perren A. , Mahendrakar S. , Rajak R.
Published: May 2021

Background:

Vertebral fragility fractures (VFFs) are commonly underdiagnosed, often resulting in chronic pain and reduced quality of life. It is particularly important to identify and manage VFFs, as they are important predictors of future VFFs and non-VFFs. Patients with VFFs often have multiple risk factors, which are important to identify to formulate a tailored and appropriate management plan. There is a paucity of studies that have investigated risk factors specifically for VFFs.

Objectives:

To identify the prevalence of osteoporosis risk factors in patients with VFFs.

Methods:

Retrospective review of patients seen between July 2018 and July 2019 at Purley Memorial Hospital, covering a large urban borough. Patients included in the study had prevalent moderate and severe VFFs (defined by Ghent criteria).

Results:

84 patients were included, of which there were 71 females and 13 males. Median age was 76 (IQR 67 – 82) and BMI was 25 (IQR 21 – 27), with 6% of patients noted to be underweight (BMI <18.5). 38% of patients had a family history of osteoporosis and 21% of patients reported a history of parental hip fracture. 21% of patients had experienced recurrent falls. Over half (56%) of patients were noted to have had 2-or-more previous fragility fractures. Of the female cohort, 24% had early menopause, 13% were nulliparous and 1% had late menarche. Of the modifiable risk factors, alcohol (24%), sedentary lifestyle (21%) and smoking (13%) were the most common. Thyroid-disease (18%) was the most common medical condition associated, followed by coeliac/malabsorption (7%), endocrinopathy (6%) and COPD (6%). Proton Pump Inhibitors (PPIs) and steroids were the most common medications associated with 16% and 14% of cases respectively. 73% of patients had good calcium intake and 62% had calcium supplements. Overall, 27 patients had 3-or-fewer risk factors, 35 patients had 4-to-6 risk factors, 19 had 7-to-9 risk factors, and 3 had greater than 10 risk factors.

Conclusion:

Our study identified several risk factors and their prevalence. The majority of patients were female, of which 24% had early menopause. Several modifiable risk factors such as low BMI, alcohol, smoking and sedentary lifestyle were commonly seen, emphasising the need to identify these risk factors in the initial consultation. Over half of patients (56%) had had 2-or-more previous non-VFFs, suggesting the need to screen for VFFs in patients with multiple fragility fractures at baseline assessment. A number of co-existing medical conditions were also observed with thyroid disease being the most prevalent. PPIs and steroids were found to be important risk factors, which may lead to the consideration of alternative medications. Overall, it was found that patients had multiple risk factors, thus it is important to have a holistic assessment of VFF patients and a multi-system management approach to prevent future fractures.

Disclosure of Interests:

None declared.
AB0865-HPR FREQUENCY OF DEPRESSION IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Cano Garcia L. , Manrique Arija S. , Godoy-Navarrete F. , Cabezas-Lucena A. M. , Diaz-Cordobes G. , Mena-Vázquez N.
Published: May 2021

Objectives:

Cross-sectional observational study of a series of SLE patients selected from the Rheumatology consultations.

Methods:

age ≥18 years with SLE (ACR 1997 criteria) capable of understanding and willing to take the questionnaires. Protocol: All patients with SLE undergoing follow-up in the rheumatology clinic are recorded in a database. A telephone call was made to all the patients included in the database and those patients who responded to the call and gave their verbal consent for the collection of data from their clinical history and completed the Goldberg questionnaire were finally included. The nurse was in charge of explaining the questionnaire to the patients. Variables: the main outcome variable was depression assessed by Goldberg (≥2 depression) and other variables were: previous diagnosis of depression, Charlson index, polypharmacy, psychiatric medication, referral to mental health or primary care, SLEDAI and SLICC. Descriptive, bivariate statistical analysis and multivariate logistic regression analysis (VD: Goldberg depression).

Results:

89 patients with SLE were included (95.5% women, mean age 49.44 ± 13.2 years and 18.28 ± 9.19 years of disease). The mean (SD) of the Goldberg scale in all the patients was 3.2 ± 2.9 and a total of 45 patients (50.4%) met criteria of depression according to Goldberg’s screening, of which 19 (21.3%) patients had a previous diagnosis of depression. Only 9 patients (10.1%) had had a mental health follow-up and 22 patients (24.7%) were being followed by the family doctor. A total of 87 patients (97.8%) presented polypharmacy: severe polypharmacy 59 (66.3%) and 33 (37.1%) psychiatric medication. The most used psychiatric medication was: 7 (7.8%) bromazepam, 6 (6.7%) citalopram, 5 (5.6%) diazepam. Regarding comorbidities, the Charlson index was 1.82 ± 1.21, also highlighting that 34 (27%) of the sample had Sjögren syndrome. In the multivariate analysis, polypharmacy (OR, 1.8 [95% CI, 1.0-3.1]) and Sjogren’s syndrome (OR, 3.8 [95% CI, 1.0-10.7]) were independently associated with depression by Goldberg.

Conclusion:

Depression is underdiagnosed and undertreated in patients with SLE. Depression is associated with polypharmacy and the perception of patients with SLE of being ill. It is important to correctly treat depression in the context of SLE comorbidity due to its great impact on quality of life.

Disclosure of Interests:

None declared
AB0601 COMPARISON OF THE EFFECT OF DIFFERENT PHYSICAL THERAPY PROGRAM IN THE REHABILITATION OF KNEE OSTEOARTHRITIS PATIENTS
Authors: Vizdoaga A. , Salaru V. , Cebanu M. , Sadovici-Bobeica V. , Loghin-Oprea N. , Mazur-Nicorici L. , Rotaru T. , Garabajiu M. , Mazur M.
Published: May 2021

Background:

Knee osteoarthritis (OA) is an increasingly common and disabling problem in worldwide. Exercises are considered the cornerstone of non-surgical management of knee OA and is recommended in all current clinical guidelines. The diversity of exercise programs determines the need to compare their efficiency, in order to recommend the best option for the patient.

Objectives:

The aim of the present study was to compare the effect on knee functionality of conventional exercises program and combinate with manual therapy in patients with knee osteoarthritis.

Methods:

164 patients that fulfilled the ACR classification criteria for knee osteoarthritis (127 females and 37 males) ranging in age from 42 to 84 years (mean 62,2 SD 8,76), participated in a 10 days two-arm randomized trial. One group (Gr.1) received an exercises program, the other group additionally manual therapy methods (Gr.2). Pain and function were measured with a Visual Analogue Scale (VAS, mm) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) with 5 domains (Pain, Symptoms, Activity in Daily Living (ADL), Sport and recreation (Sport/rec.) and Quality of life (QoL)).

Results:

In the Gr.1 were 82 patients mean age 61,8±9,2 years and in Gr.2 – 82 patients 62,7±8,3 years (p>0.05). The initial level of pain (63,4±14,2 vs 60,2±18,8mm) and knee functionality according to KOOS (Tab1.) were similar in both groups, p>0.05. After 10 days rehabilitation program, VAS in Gr.1 was 39,6±14,8 mm, in Gr.2- 28,5±11,6 mm, (p<0.01). The KOOS results at the end of the rehabilitation program were with improvement, statistically significative in the Gr.2 (p<0,05).

Table 1.

The KOOS results at baseline and after 10 days of rehabilitation program.

KOOS scales
(M±SD), %Group 1Group 2BaselineAfter 10 daysBaselineAfter 10 daysPain55,5 ±13,863,4±13,653,0±22,364,3±19,1Symptoms59,0±18,765,6±18,156,6±19,069,0±15,9ADL46,3±15,554,5±16,043,0±19,955,1±18,2Sport/rec15,6±17,323,1±19,616,0±24,330,5±23,6QoL29,3±22,236,5± 22,934,8±23,950,6±18,9

Conclusion:

The reduction of pain and recovery of function were found in both groups, with better results in patients who received manual therapy and exercises program. This study supports the routine manual therapy in rehabilitation program in patients with knee osteoarthritis.

Disclosure of Interests:

None declared.
Exploring equity in health and poverty impacts of control measures for SARS-CoV-2 in six countries
Authors: Sweeney Sedona , Capeding Theo Prudencio Juhani , Eggo Rosalind , Huda Maryam , Jit Mark , Mudzengi Don , Naylor Nichola R , Procter Simon , Quaife Matthew , Serebryakova Lela , Torres-Rueda Sergio , Vargas Veronica ,   CHiL COVID Working Group, Vassall Anna
Published: May 2021

Background

Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions.

Methods

We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, UK, the Philippines and South Africa. We consider impact of lockdown in terms of ability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage in a scenario analysis.

Results

In all examined countries, socioeconomic status (SES) quintiles 1–3 were disproportionately more likely to experience income loss (70% of people) and inability to socially distance (68% of people) than higher SES quintiles. Improving social protection increased the percentage of the workforce able to socially distance from 48% (33%–60%) to 66% (44%–71%). We estimate the cost of this social protection would be equivalent to an average of 0.6% gross domestic product (0.1% Pakistan–1.1% Chile).

Conclusions

We illustrate the potential for using publicly available data to rapidly assess the equity implications of social protection and non-pharmaceutical intervention policy. Social protection is likely to mitigate inequitable health and economic impacts of lockdown. Although social protection is usually targeted to the poorest, middle quintiles will likely also need support as they are most likely to suffer income losses and are disproportionately more exposed.
Sibling rank and sibling number in relation to cardiovascular disease and mortality risk: a nationwide cohort study
Authors: Nilsson Peter M , Sundquist Jan , Sundquist Kristina , Li Xinjun
Published: May 2021

Background

The number and rank order of siblings could be of importance for risk of cardiovascular disease and mortality. Previous studies have used only fatal events for risk prediction. We, therefore, aimed to use also non-fatal coronary and cardiovascular events in fully adjusted models.

Methods

From the Multiple-Generation Register in Sweden, data were used from 1.36 million men and 1.32 million women (born 1932–1960), aged 30–58 years at baseline and with follow-up from 1990 to 2015. Mean age at follow-up was 67 years (range 55–83 years). Fatal and non-fatal events were retrieved from national registers.

Results

Compared with men with no siblings, those with 1–2 siblings had a lower, and those with four or more siblings had a higher adjusted risk of cardiovascular events. Again, compared with men with no siblings, those with more than one sibling had a lower total mortality risk, and those with three or more siblings had an increased risk of coronary events.

Correspondingly, compared with women with no siblings those women with three siblings or more had an increased risk of cardiovascular events, and those with two siblings or more had an increased risk of coronary events. Women with one sibling or more were at lower total mortality risk, following full adjustment.

Conclusion

Being first born is associated with a favourable effect on non-fatal cardiovascular and coronary events for both men and women. The underlying biological mechanisms for this should be studied in a sociocultural context.
COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus—protocol for a cluster randomised controlled trial
Authors: Richards David A , Sugg Holly VR , Cockcroft Emma , Cooper Joanne , Cruickshank Susanne , Doris Faye , Hulme Claire , Logan Phillipa , Iles-Smith Heather , Melendez-Torres G.J , Rafferty Anne Marie , Reed Nigel , Russell Anne-Marie , Shepherd Maggie , Singh Sally J , Thompson Coon Jo , Tooze Susannah , Wootton Stephen , Abbott Rebecca , Bethel Alison , Creanor Siobhan , Quinn Lynne , Tripp Harry , Warren Fiona C , Whear Rebecca , Bollen Jessica , Hunt Harriet A , Kent Merryn , Morgan Leila , Morley Naomi , Romanczuk Lidia
Published: May 2021

Introduction

Patient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse–patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs.

Methods and analysis

we aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients’ Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations.

Ethics and dissemination

Research governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University’s FutureLearn web platform.

Trial registration number

ISRCTN13177364; Pre-results.
Exploring family based immigrant youth substance use prevention programmes: a scoping review protocol
Authors: Li Yiyan , Maina Geoffrey , Pandey Mamata , Amoyaw Jonathan , Fang Yiting
Published: May 2021

Introduction

Canada has one of the highest rates of problematic opiate and alcohol use in the world. Globally, Canada was the second country that legalized marijuana for non-medical use. As Canada is an immigrant-receiving country, newcomers and immigrants contend with a substance use landscape that was likely absent in their countries of origin. Although immigrants have lower rates of substance use than the host population, the risk of substance use, especially among youth, increases with acculturation and peer pressure. While parents are best placed to mitigate the risks for substance use among their youth, immigrant parents often do not have the knowledge and skills to do so. Therefore, culturally adaptable family based interventions need be explored to build immigrant parents’ capacities to mitigate substance use risks.

Aim and purpose

The aim of this scoping review is to explore family based substance use prevention interventions for immigrant youth, which will be guided by two questions:

What is known about family based interventions for preventing immigrant adolescents’ substance use?

What are the features and study results of these intervention protocols?

Methods and analysis

We will apply Arksey and O’Malley’s procedure for reporting scoping review and report study findings based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews.

Discussion

We hope that the knowledge translation emanating from this review will increase immigrant parents’ knowledge of substance use and enable them to effectively intervene to prevent substance use among their youth. We also hope that this work can inform policy development on best practices for substance use prevention and for the creation of culturally sensitive programmes and services for immigrant youth.
Protocol for an observational cohort study identifying factors predicting accurately end of life in dementia with Lewy bodies and promoting quality end-of-life experiences: the PACE-DLB study
Authors: Armstrong Melissa J , Paulson Henry L , Maixner Susan M , Fields Julie A , Lunde Angela M , Boeve Bradley F , Manning Carol , Galvin James E , Taylor Angela S , Li Zhigang
Published: May 2021

Introduction

Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias. Despite the fact that most individuals with DLB die from complications of the disease, little is known regarding what factors predict impending end of life or are associated with a quality end of life.

Methods and analysis

This is a multisite longitudinal cohort study. Participants are being recruited from five academic centres providing subspecialty DLB care and volunteers through the Lewy Body Dementia Association (not receiving specialty care). Dyads must be US residents, include individuals with a clinical diagnosis of DLB and at least moderate-to-severe dementia and include the primary caregiver, who must pass a brief cognitive screen. The first dyad was enrolled 25 February 2021; recruitment is ongoing. Dyads will attend study visits every 6 months through the end of life or 3 years. Study visits will occur in-person or virtually. Measures include demographics, DLB characteristics, caregiver considerations, quality of life and satisfaction with end-of-life experiences. For dyads where the individual with DLB dies, the caregiver will complete a final study visit 3 months after the death to assess grief, recovery and quality of the end-of-life experience. Terminal trend models will be employed to identify significant predictors of approaching end of life (death in the next 6 months). Similar models will assess caregiver factors (eg, grief, satisfaction with end-of-life experience) after the death of the individual with DLB. A qualitative descriptive analysis approach will evaluate interview transcripts regarding end-of-life experiences.

Ethics and dissemination

This study was approved by the University of Florida institutional review board (IRB202001438) and is listed on clinicaltrials.gov (NCT04829656). Data sharing follows National Institutes of Health policies. Study results will be disseminated via traditional scientific strategies (conferences, publications) and through collaborating with the Lewy Body Dementia Association, National Institute on Aging and other partnerships.
Measuring the impact of COVID-19 on the quality of life of the survivors, partners and family members: a cross-sectional international online survey
Authors: Shah Rubina , Ali Faraz M , Nixon Stuart J , Ingram John R , Salek Sam M , Finlay Andrew Y
Published: May 2021

Objective

This study aimed to measure the impact of COVID-19 on the quality of life (QoL) of survivors and their partners and family members.

Design and setting

A prospective cross-sectional global online survey using social media.

Participants

Patients with COVID-19 and partners or family members (age ≥18 years).

Intervention

Online survey from June to August 2020.

Main outcome measure

The EuroQol group five dimensions three level (EQ-5D-3L) to measure the QoL of survivors of COVID-19, and the Family Reported Outcome Measure (FROM-16) to assess the impact on their partner/family member’s QoL.

Results

The survey was completed by 735 COVID-19 survivors (mean age=48 years; females=563) at a mean of 12.8 weeks after diagnosis and by 571 partners and 164 family members (n=735; mean age=47 years; females=246) from Europe (50.6%), North America (38.5%) and rest of the world (10.9%). The EQ-5D mean score for COVID-19 survivors was 8.65 (SD=1.9, median=9; range=6–14). 81.1% (596/735) reported pain and discomfort, 79.5% (584/735) problems with usual activities, 68.7% (505/735) anxiety and depression and 56.2% (413/735) problems with mobility. Hospitalised survivors (20.1%, n=148) and survivors with existing health conditions (30.9%, n=227) reported significantly more problems with mobility and usual activities (p<0.05), with hospitalised also experiencing more impact on self-care (p≤0.001). Among 735 partners and family members, the mean FROM-16 score (maximum score=highest impact =32) was 15 (median=15, range=0-32). 93.6% (688/735) reported being worried, 81.7% (601/735) frustrated, 78.4% (676/735) sad, 83.3% (612/735) reported impact on their family activities, 68.9% (507/735) on sleep and 68.1% (500/735) on their sex life.

Conclusion

COVID-19 survivors reported a major persisting impact on their physical and psychosocial health. The lives of their partners and other family members were also severely affected. There is a need for a holistic support system sensitive to the needs of COVID-19 survivors and their family members who experience a major ‘secondary burden’.
Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm
Authors: Kohns Vasconcelos Malte , Weil Katharina , Vesterling-Hörner Daniela , Klemm Mehrsad , el Scheich Tarik , Renk Hanna , Remke Katharina , Bosse Hans Martin
Published: May 2021

Objectives

Globally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care.

Design

Survey of paediatric primary care practices on consultation numbers and patient management changes, and semistructured interviews to identify challenges for patient care. Surveys and interviews were partially linked in an explanatory sequential design to identify patient groups perceived to be at higher risk for worse care during the pandemic.

Setting

In and around Düsseldorf, a densely populated area in Western Germany. The primary care facilities are spread over an area with approximately 2 million inhabitants.

Participants

Primary care in Germany is provided through practices run by self-employed specialist physicians that are contracted to offer services to patients under public health insurance which is compulsory to the majority of the population. The sample contained 44 paediatric primary care practices in the area, the response rate was 50%.

Results

Numbers of consultations for scheduled developmental examinations remained unchanged compared with the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March–May 2020 compared with 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter.

Conclusions

Primary care paediatricians offered stable service through the early pandemic but expected strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.
Multimodality imaging for the diagnosis of infiltrative cardiomyopathies
Authors: Vidula Mahesh K , Bravo Paco E
Published: May 2021

Infiltrative cardiomyopathies result from the deposition or anomalous storage of specific substances in the heart, leading to impaired cardiac function and heart failure. In this review, we describe the utility of a variety of imaging modalities for the diagnosis of infiltrative cardiomyopathies and provide algorithms for clinicians to use to evaluate patients with these disorders. We have divided infiltrative cardiomyopathies into two different categories: (1) infiltrative cardiomyopathies characterised by increased wall thickness (eg, cardiac amyloidosis and Anderson-Fabry disease (AFD)) and (2) infiltrative cardiomyopathies that can mimic ischaemic or dilated cardiomyopathies (eg, cardiac sarcoidosis (CS) and iron overload cardiomyopathy). Echocardiography is the first modality of choice for the evaluation of cardiomyopathies in either category, and the differential can be narrowed using cardiac magnetic resonance (CMR) and nuclear imaging techniques. The diagnosis of cardiac amyloidosis is supported with key findings seen on echocardiography, CMR and nuclear imaging, whereas AFD can be suggested by unique features on CMR. CMR and nuclear imaging are also important modalities for the diagnosis of CS, while iron overload cardiomyopathy is mostly diagnosed using tissue characterisation on CMR. Overall, multimodality imaging is necessary for the accurate non-invasive diagnosis of infiltrative cardiomyopathies, which is important to ensure appropriate treatment and prognostication.
Diagnosis, management and therapeutic strategies for congenital long QT syndrome
Authors: Wilde Arthur A M , Amin Ahmad S , Postema Pieter G
Published: May 2021

Congenital long QT syndrome (LQTS) is characterised by heart rate corrected QT interval prolongation and life-threatening arrhythmias, leading to syncope and sudden death. Variations in genes encoding for cardiac ion channels, accessory ion channel subunits or proteins modulating the function of the ion channel have been identified as disease-causing mutations in up to 75% of all LQTS cases. Based on the underlying genetic defect, LQTS has been subdivided into different subtypes. Growing insights into the genetic background and pathophysiology of LQTS has led to the identification of genotype–phenotype relationships for the most common genetic subtypes, the recognition of genetic and non-genetic modifiers of phenotype, optimisation of risk stratification algorithms and the discovery of gene-specific therapies in LQTS. Nevertheless, despite these great advancements in the LQTS field, large gaps in knowledge still exist. For example, up to 25% of LQTS cases still remain genotype elusive, which hampers proper identification of family members at risk, and it is still largely unknown what determines the large variability in disease severity, where even within one family an identical mutation causes malignant arrhythmias in some carriers, while in other carriers, the disease is clinically silent. In this review, we summarise the current evidence available on the diagnosis, clinical management and therapeutic strategies in LQTS. We also discuss new scientific developments and areas of research, which are expected to increase our understanding of the complex genetic architecture in genotype-negative patients, lead to improved risk stratification in asymptomatic mutation carriers and more targeted (gene-specific and even mutation-specific) therapies.
Association of inverted T wave during atrial fibrillation rhythm with subsequent cardiac events
Authors: Kawaji Tetsuma , Ogawa Hisashi , Hamatani Yasuhiro , Kato Masashi , Yokomatsu Takafumi , Miki Shinji , Abe Mitsuru , Akao Masaharu
Published: May 2021

Objective

The clinical significance of ECG abnormalities during atrial fibrillation (AF) rhythm is poorly understood. The aim of the current study was to explore the impact of inverted T wave on cardiac prognosis in patients with AF.

Methods

The current study enrolled 2709 patients with AF whose baseline ECG was available from a Japanese community-based prospective survey, the Fushimi AF Registry, and the impact of inverted T wave in baseline ECG at AF rhythm on the composite of cardiac death, myocardial infarction and hospitalisation due to heart failure was examined.

Results

Intraventricular conduction delay, ST segment depression and inverted T wave were observed in 15.8%, 24.7% and 41.4% of baseline ECG with a mean heart rate of 94.7 beats per minute. The median follow-up duration was 5.0 years. The incidence rate of the composite cardiac endpoint was significantly higher in patients with inverted T wave than those without (5.8% vs 3.3% per patient-year, log-rank p<0.01). The higher risk associated with inverted T wave was consistent even for individual components of the composite cardiac endpoint. By multivariable analysis, inverted T wave was an independent predictor of the composite cardiac endpoint (HR 1.53, 95% CI 1.26 to 1.85, p<0.01). Inverted T wave was detected in 15.7% at anterior leads, 19.8% at inferior leads and 26.6% at lateral leads. The location of inverted T wave was not associated with risk of composite cardiac endpoint.

Conclusions

Inverted T wave was commonly observed in patients with AF and its presence during AF rhythm was associated with subsequent cardiac events.
Audit of medical (non-targeted) liver biopsy specimen quality, pathology reporting and effect on patient management
Authors: Seth Sidhant , Forrest Ewan H , Morris Judith M , Heydtmann Mathis , Konanahalli Prakash , Kohnen Gabriele , Oien Karin A
Published: May 2021

Aims

To evaluate our medical liver pathology practice and its influence on patient management, using audit templates published by the UK Royal College of Pathologists (RCPath).

Methods

We audited medical liver biopsies reported in our centre in 2019 using RCPath proformas. Data were collected from pathology reports and corresponding electronic patient record.

Results

60 cases were selected for audit from 135 eligible biopsies reported in 2019. 58/60 cases were core biopsies and 2/60 were laparoscopic wedge biopsies. 53/57 (93%) core biopsies with available data met RCPath adequacy criteria (length >15 mm and/or ≥6 portal tracts). Most reports (57/60; 95%) were judged to have helped patient management. 25/60 (42%) biopsy reports helped to clarify the clinical diagnosis and 48/60 (80%) led to altered management.

Conclusions

We demonstrate the utility of the RCPath audit templates, highlighting the clinical value of medical liver biopsies in the diagnostic work-up and management of patients with liver disease.
The intersectional role of social stress in fracture risk: results from the Women’s Health Initiative
Authors: Follis Shawna , Klimentidis Yann C , Bea Jennifer , Hu Chengcheng , Garcia David , Wactawski-Wende Jean , Kohler Lindsay , Shadyab Aladdin H , Flores Melissa , Tindle Hilary A , Chen Zhao
Published: May 2021

Background

The biological consequences of stress from the social environment pattern health outcomes. This study investigated whether social stress is prospectively associated with fracture incidence among racially and ethnically diverse, postmenopausal women.

Methods

Data from 160 709 postmenopausal women in the Women’s Health Initiative was analysed using Cox proportional hazards regression models to examine prospective associations of social stress with time to total and hip fracture incidence. Self-reported questionnaires measuring social strain, social functioning and social support were used to assess social stress.

Results

Age and race/ethnicity modified associations between social stress and total and hip fractures. HRs for the associations between higher social support (indicating lower social stress) and total fractures among those age 50–59 years were 0.92 (95% CI: 0.90 to 0.94); HR=0.94 (95% CI: 0.93 to 0.95) for those age 60–69 years and HR=0.96 (95% CI: 0.95 to 0.98) for those age 70–79 years. Higher social strain was associated with greater hip fracture incidence among Native American women (HR=1.84, 95% CI: 1.10 to 3.10), Asian women (HR=1.37, 95% CI: 1.01 to 1.86) and white women (HR=1.04, 95% CI: 1.01 to 1.08).

Conclusion

Identifying population patterns of fracture incidence as biological expressions of social environments reveals how race/ethnic specific social environmental factors influence disparities in fractures.
Impact and Role of Pulmonary Embolism Response Teams in Venous Thromboembolism Associated with Covid-19
Authors: Porres-Aguilar Mateo , Tapson Victor F , Rivera-Lebron Belinda N , Rali Parth M , Jiménez David , Porres-Muñoz Mateo , Barraza Sarah , Muñoz Oscar C , Mukherjee Debabrata
Published: May 2021

Venous thromboembolism associated with COVID-19, particularly acute pulmonary embolism, may represent a challenging and complex clinical scenario. The benefits of having a multidisciplinary pulmonary embolism response team (PERT) can be important during such a pandemic. The aim of PERT in the care of such patients is to provide fast, appropriate, multidisciplinary, team-based approach, with the common goal to tailor the best therapeutic decision making, prioritizing always optimal patient care, especially given lack of evidence-based clinical practice guidelines in the setting of COVID-19, which potentially confers a significant prothrombotic state. Herein, we would like to briefly emphasize the importance and potential critical role of PERT in the care of patients in which these two devastating illnesses are present together.