bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief Report: Low Incidence of Hepatitis C Among a Cohort of HIV-Negative Gay and Bisexual Men Using HIV Pre-exposure Prophylaxis (PrEP) in Melbourne, Australia, and the Contribution of Sexual Transmission
Authors: Cornelisse Vincent J. , Traeger Michael W. , Wright Edwina J. , Murphy Dean , Stoové Mark , Hellard Margaret , Sacks-Davis Rachel , Asselin Jason , Fairley Christopher K. , Doyle Joseph , Sasadeusz Joseph
Published: March 2021

Background:

PrEPX was an Australian HIV pre-exposure prophylaxis (PrEP) study conducted between 2016 and 2018. This analysis aimed to estimate hepatitis C (HCV) incidence and explore likely modes of transmission.

Setting:

Cohort study of PrEP users in Victoria, Australia.

Methods:

HCV tests were conducted at enrollment and every 12 months thereafter. HCV incident cases were identified from laboratory data. Likely modes of transmission were inferred from computer-assisted self-interviews, medical records, and interviews.

Results:

Among 3202 PrEPX participants tested for HCV at baseline, HCV RNA-positive prevalence was 0.22% (95% confidence interval: 0.09 to 0.45). Among participants testing HCV antibody-negative or RNA-negative at baseline, 2058 had at least one follow-up HCV test. Eight incident HCV cases were identified during 2111 person-years of follow-up (incidence 0.38/100 person-years); all were primary infections in men who had sex with men. Clinical, laboratory, and computer-assisted self-interviews data were available for all, and 6 cases were interviewed. Three cases were attributable to injecting drug use (IDU). A fourth case reported IDU, but his HCV was attributable to sexual transmission. Four other cases reported no IDU and probably acquired HCV sexually. Most cases reported anal trauma in the context of condomless receptive anal intercourse during group sex at sex-on-premises venues.

Conclusions:

In PrEPX, HCV incidence was low compared to international PrEP studies, and most cases were transmitted sexually. Our findings highlight the need for HCV prevention messaging by clinicians, in sex-on-premises venues, and on digital platforms used to arrange group sex; and the need for HCV screening among some PrEP-using men who have sex with men.
The intracellular phase of extracellular respiratory tract bacterial pathogens and its role on pathogen-host interactions during infection
Authors: Lamberti Yanina , Surmann Kristin
Published: March 2021

Purpose of review

An initial intracellular phase of usually extracellular bacterial pathogens displays an important strategy to hide from the host's immune system and antibiotics therapy. It helps the bacteria, including bacterial pathogens of airway diseases, to persist and eventually switch to a typical extracellular infection. Several infectious diseases of the lung are life-threatening and their control is impeded by intracellular persistence of pathogens. Thus, molecular adaptations of the pathogens to this niche but also the host's response and potential targets to interfere are of relevance. Here we discuss examples of historically considered extracellular pathogens of the respiratory airway where the intracellular survival and proliferation is well documented, including infections by Staphylococcus aureus, Bordetella pertussis, Haemophilus influenzae, Pseudomonas aeruginosa, and others.

Recent findings

Current studies focus on bacterial factors contributing to adhesion, iron acquisition, and intracellular survival as well as ways to target them for combatting the bacterial infections.

The investigation of common and specific mechanisms of pathogenesis and persistence of these bacteria in the host may contribute to future investigations and identifications of relevant factors and/or bacterial mechanisms to be blocked to treat or improve prevention strategies.
Craniofacial Surgery-Related Hashtag Utilisation on Instagram
Authors: Kilcoyne Sarah , Rogers Constance , Thomas Gregory P.L. , Wall Steven , Johnson David
Published: March 2021

Background:

Patients, parents, and carers are increasingly using social media to access and contribute to health information. There are currently 3.484 billion active social media users. Instagram is a primarily visual social media platform for sharing photographs and videos with currently over one billion monthly active users. Limited research has investigated the use of Instagram in healthcare contexts including plastic surgery, and in the treatment of specific conditions, such as fibromyalgia and scoliosis. This study aimed to investigate the use of Instagram in relation to craniofacial surgery.

Methods:

The authors investigated the use of 12 Instagram craniofacial surgery-related hashtags. Quantitative and qualitative data were collected for each of the “top” nine posts associated with each hashtag. Duplicate posts, posts not in English and those not relevant to craniofacial surgery were excluded.

Thematic analysis was then used to qualitatively evaluate the captions and comments of each of the nine “top” posts associated with each hashtag.

Results:

A total number of 151,738 posts were identified using the 12 hashtags queried in the present study, with #craniofacial being the most popular hashtag (87% of posts). Parents (n = 25, 33%) and surgeons (n = 25, 33%) were responsible for the majority of posts. A heterogenous group were responsible for the remaining 34% of posts.

Results indicated that parents and surgeons posted significantly different images (chi-squared with Yates correlation is 25.0519, P 
< 0.00001). Parents’ posts were predominantly images of their child/patients (n = 24) compared to posts about patients by surgeons (n = 6). Posts by surgeons were predominantly images of professionals (n = 14) compared to images of professionals posted by parents (n = 1).

Results of qualitative analysis of captions of posts indicated a significant difference in themes that emerged between parents and surgeons; with surgeons largely using Instagram for information giving, and parents for sharing of experiences (chi-square (n = 108) = 40.83, P 
< 0.00001).

There was a significant difference (two-tailed t test, P 
= 0.002) in engagement (measured by the number of likes on posts) on posts by parents (mean = 3778) compared to posts by surgeons (mean = 135.4)

Conclusions:

Results indicate that craniofacial-surgery related posts on Instagram provide a medium to allow individuals and families with rare disorders to connect and share their experiences. The use of Instagram to share information about craniofacial abnormalities via Instagram has the potential to be used by healthcare professionals to educate and support patients and families.
Maxillary Changes Following Facial Bipartition – A Three-Dimensional Quantification
Authors: Rickart Alexander J. , van de Lande Lara S. , O'Sullivan Eimear , Ong Juling , Gill Daljit S. , Evans Robert D. , Schievano Silvia , Dunaway David J.
Published: March 2021

Introduction:

Children with Apert syndrome have hypertelorism and midfacial hypoplasia, which can be treated with facial bipartition (FB), often aided by rigid external distraction. The technique involves a midline osteotomy that lateralizes the maxillary segments, resulting in posterior cross-bites and midline diastema. Varying degrees of spontaneous realignment of the dental arches occurs postoperatively. This study aims to quantify these movements and assess whether they occur as part of a wider skeletal relapse or as dental compensation.

Methods:

Patients who underwent FB and had high quality computed tomography scans at the preoperative stage, immediately postsurgery, and later postoperatively were reviewed. DICOM files were converted to three-dimensional bone meshes and anatomical point-to-point displacements were quantified using nonrigid iterative closest point registration. Displacements were visualized using arrow maps, thereby providing an overview of the movements of the facial skeleton and dentition.

Results:

Five patients with Apert syndrome were included. In all cases, the arrow maps demonstrated initial significant anterior movement of the frontofacial segment coupled with medial rotation of the orbits and transverse divergence of the maxillary arches. The bony position following initial surgery was shown to be largely stable, with primary dentoalveolar relapse correcting the dental alignment.

Conclusions:

This study showed that spontaneous dental compensation occurs following FB without compromising the surgical result. It may be appropriate to delay active orthodontic for 6-months postoperatively until completion of this early compensatory phase.
The Kiss Flap Technique: An Alternative Concept for Reconstruction of Extensive Scalp Defects
Authors: Krakowczyk Łukasz , Opyrchał Jakub , Piotrowska-Seweryn Agnieszka
Published: March 2021

The main scope of the kiss flap technique is to harvest double-skin paddle flaps, narrower than those harvested in a standard manner and rearrange them side-by-side (“kissing”) in order to match the exact size and contour of the defect. Apart from the possibility of custom-designing the desired shape of soft tissue coverage, the kiss technique enables tension-free direct closure of the donor site, reducing its morbidity and improving aesthetic appearance. In this paper, two patients with severe scalp defects after cancer resections are presented. Due to poor elasticity of surrounding tissues, complexity of composite defect together with extensive range of resection: the kiss technique was applied to the anterolateral thigh flap in both cases. Possibility of implementing the described method in almost all perforator-based flaps is encouraging. Although, prolonged operating time, the necessity of meticulous preoperative perforator mapping as well as extended surgical dissection should be taken into consideration when planning kiss flaps.
Evaluation of Three-Dimensional Heads up Ophthalmic Surgery Demonstration From the Perspective of Surgeons and Postgraduate Trainees
Authors: Cheng Teck Chee , Yahya Maliha Farah Nurhazirah , Mohd Naffi Ainal Adlin , Othman Othmaliza , Seng Fai Tang , Yong Meng Hsien , Wan Abdul Halim Wan Haslina , Mustapha Mushawiahti , Che Hamzah Jemaima , Md Din Norshamsiah , Bastion Mae-Lynn Catherine
Published: March 2021

Background:

To evaluate the satisfaction of surgeons and trainees with three-dimensional (3D) ophthalmic surgery during a demonstration compared to traditional surgery

Methods:

This validated questionnaire-based study was conducted over 1-month during which Ngenuity 3D surgery was demonstrated. All surgeons and trainees exposed were recruited to complete a questionnaire comprising visualization, physical, ease of use, teaching and learning, and overall satisfaction.

Results:

All 7 surgeons and 33 postgraduate students responded. Surgeons reported no significant difference except overall (P = 0.047, paired t-test). Postgraduate trainees reported significantly better experience with 3D for illumination (P = 0.008), manoeuvrability (P = 0.01), glare (P = 0.037), eye strain (P = 0.008), neck and upper back strain (P = 0.000), lower back pain (P = 0.019), communication (P = 0.002), comfortable environment (P = 0.001), sharing of knowledge (P = 0.000), and overall (P = 0.009).

Conclusions:

During early experience, surgeons and trainees reported better satisfaction with 3D overall. Trainees had better satisfaction with 3D in various subcomponents of visualization, physical, ease of use, and education.
Capsaicin 8% patch Qutenza and other current treatments for neuropathic pain in chemotherapy-induced peripheral neuropathy (CIPN)
Authors: Privitera Rosario , Anand Praveen
Published: March 2021

Purpose of review

Current oral treatments for neuropathic pain associated with chemotherapy-induced peripheral neuropathy (CIPN) have limited clinical efficacy, and undesirable side-effects. Topically delivered treatments have the advantage of avoiding CNS side-effects, while relieving pain. We have reviewed treatments of neuropathic pain associated with CIPN, focusing on the Capsaicin 8% patch, which can provide pain relief for up to 3 months or longer after a single 30–60-min application.

Recent findings

Capsaicin 8% patch is a licensed treatment in the EU/UK for neuropathic pain and shown to be safe and effective in providing pain relief for patients with CIPN. Repeated daily oral or topical administrations are not required, as with other current treatments. The side-effects are transient and restricted to the time around patch application. New evidence suggests the Capsaicin 8% patch can promote the regeneration and restoration of skin nerve fibres in CIPN, in addition to the pain relief.

The Capsaicin 8% patch is now often a preferred a treatment option for localised neuropathic pain conditions, including the feet and hands in patients with CIPN. Capsaicin 8% patch can be repeated three-monthly, if needed, for a year. In addition to pain relief, it may have a disease-modifying effect.
Pain in Parkinson's disease: Mechanism-based treatment strategies
Authors: Rukavina Katarina , Cummins Tatum M. , Chaudhuri K. Ray , Bannister Kirsty
Published: March 2021

Purpose of review

Chronic pain, highly prevalent throughout the course of Parkinson's disease (PD), has been ranked as one of the top ten most bothersome symptoms people with Parkinson's (PwP) are experiencing. Yet, robust evidence-based treatment strategies are lacking. This unmet need is partly attributable to the multifaceted nature of PD-related pain, which results in part from a complex and poorly understood interplay involving a range of neurotransmitter pathways. Degeneration of nigrostriatal dopaminergic pathways and alterations of central nervous system extra-striatal dopaminergic, noradrenergic, serotoninergic, glutamatergic, opioidergic and endocannabinoid circuits may all promote a heightened experience of pain in PwP. Thus, the potential targets for mechanism-based pain-relieving strategies in PwP are several. These targets are discussed herein.

Recent findings

An increasing number of clinical trials and experimental studies in animal models of PD are being designed with the aim of addressing the pathophysiological mechanism(s) underlying PD-related pain. Overall, recent research findings highlight the analgesic effects of dopaminergic and opioidergic medication for certain subtypes of pain in PwP, whereas proposing novel strategies that involve targeting other neurotransmitter pathways.

The origin of pain in PwP remains under investigation. Although our understanding of the mechanisms underpinning persistent pain in PD has improved in recent years, this has not yet translated to clinical alleviation of this most troublesome nonmotor symptom. Patient stratification linked with evidence-based personalized pain-treatment plans for optimal analgesic relief will rely on advances in our understanding of the dopaminergic and nondopaminergic targets outlined in this review.
Routine Office Assessment After OnabotulinumtoxinA Injection for Overactive Bladder Is Unnecessary to Detect Clinically Significant Voiding Dysfunction
Authors: Aldrich Emily R. , Pauls Rachel N.
Published: March 2021

Objective

This study aimed to determine if routine assessment of patients after onabotulinumtoxinA injections for overactive bladder is necessary to detect clinically significant voiding dysfunction.

Methods

This retrospective cross-sectional cohort study analyzed patients who underwent intravesical injection of onabotulinumtoxinA for overactive bladder during a 4-year period. Patients were included for analysis if they returned for an office follow-up visit within 1 month of administration. Baseline demographic data; procedural details; postvoid residual volumes; abnormal postprocedure voiding symptoms, including urinary frequency, pain, or inability to void; urinary tract infections; and initiation of intermittent self-catheterization were recorded. Descriptive statistics, point-biserial and Pearson correlation analyses were performed.

Results

Two hundred thirty-seven injections were included in our analysis. Fifteen encounters, from 13 patients, required the initiation of intermittent self-catheterization (6.3%). The median postvoid residual in those treated with intermittent self-catheterization was 300 mL (min, max: 200, 750 mL); all had received 100 units of onabotulinumtoxinA. The most common symptom among those requiring intermittent self-catheterization was urgency (n = 13; 87%), whereas 93% (n = 14) had at least 1 bothersome symptom. Correlation analyses showed a weak positive correlation with elevated postvoid residual volume and a history of prolapse repair (r = 0.269, P = 0.004), and prior pelvic surgery (r = 0.205, P = 0.029).

Conclusions

Clinically relevant urinary retention that required intermittent self-catheterization after onabotulinumtoxinA injection for overactive bladder occurred in 6.3% of participants in this sample. The vast majority of patients who required intermittent self-catheterization described symptoms that they were able to self-identify.
Quantitative SARS-CoV-2 anti-spike responses to Pfizer-BioNTech and Oxford-AstraZeneca vaccines by previous infection status
Authors: Eyre David W , Lumley Sheila F , Wei Jia , Cox Stuart , James Tim , Justice Anita , Jesuthasan Gerald , O’Donnell Denise , Howarth Alison , Hatch Stephanie B , Marsden Brian D , Jones E Yvonne , Stuart David I , Ebner Daniel , Hoosdally Sarah , Crook Derrick W , Peto Tim EA , Walker Timothy M , Stoesser Nicole E , Matthews Philippa C , Pouwels Koen B , Walker A Sarah , Jeffery Katie
Published: March 2021

Objectives

We investigate determinants of SARS-CoV-2 anti-spike IgG responses in healthcare workers (HCWs) following one or two doses of Pfizer-BioNTech or Oxford-AstraZeneca vaccines.

Methods

HCWs participating in regular SARS-CoV-2 PCR and antibody testing were invited for serological testing prior to first and second vaccination, and 4 weeks post-vaccination if receiving a 12-week dosing interval. Quantitative post-vaccination anti-spike antibody responses were measured using the Abbott SARS-CoV-2 IgG II Quant assay (detection threshold: ≥50 AU/ml). We used multivariable logistic regression to identify predictors of seropositivity and generalised additive models to track antibody responses over time.

Results

Vaccine uptake was 80%, but less in lower-paid roles and Black, south Asian and minority ethnic groups. 3570/3610(98.9%) HCWs were seropositive >14 days post-first vaccination and prior to second vaccination, 2706/2720(99.5%) after Pfizer-BioNTech and 864/890(97.1%) following Oxford-AstraZeneca vaccines. Previously infected and younger HCWs were more likely to test seropositive post-first vaccination, with no evidence of differences by sex or ethnicity. All 470 HCWs tested >14 days after second vaccine were seropositive. Quantitative antibody responses were higher after previous infection: median(IQR) >21 days post-first Pfizer-BioNTech 14,604(7644-22,291) AU/ml vs. 1028(564-1985) AU/ml without prior infection (p<0.001). Oxford-AstraZeneca vaccine recipients had lower readings post-first dose compared to Pfizer-BioNTech, with and without previous infection, 10,095(5354-17,096) and 435(203-962) AU/ml respectively (both p<0.001 vs. Pfizer-BioNTech). Antibody responses post-second vaccination were similar to those after prior infection and one vaccine dose.

Conclusions

Vaccination leads to detectable anti-spike antibodies in nearly all adult HCWs. Whether differences in response impact vaccine efficacy needs further study.
Using multivariable Mendelian randomization to estimate the causal effect of bone mineral density on osteoarthritis risk, independent of body mass index
Authors: Hartley April , Sanderson Eleanor , Granell Raquel , Paternoster Lavinia , Zheng Jie , Smith George Davey , Southam Lorraine , Hatzikotoulas Konstantinos , Boer Cindy G , van Meurs Joyce , Zeggini Eleftheria ,   The Genetics of Osteoarthritis consortium, Gregson Celia L , Tobias Jon H
Published: March 2021

Objectives

Observational analyses suggest that high Bone Mineral Density (BMD) is a risk factor for osteoarthritis (OA); it’s unclear whether this represents a causal effect or shared aetiology and whether these relationships are body mass index (BMI)-independent. We performed bidirectional Mendelian randomization (MR) to uncover the causal pathways between BMD, BMI and OA.

Methods

One-sample (1S)MR estimates were generated by two-stage least-squares regression. Unweighted allele scores instrumented each exposure. Two-sample (2S)MR estimates were generated using inverse-variance weighted fixed-effects meta-analysis. Multivariable MR (MVMR), including BMD and BMI instruments in the same model, determined the BMI-independent causal pathway from BMD to OA. Latent causal variable (LCV) analysis, using weight-adjusted FN-BMD and hip/knee OA summary statistics, determined if genetic correlation explained the causal effect of BMD on OA.

Results

1SMR provided strong evidence for a causal effect of eBMD on hip and knee OA (ORhip =1.28[1.05,1.57],p=0.02, ORknee =1.40[1.20,1.63],p=3×10−5, OR per SD increase). 2SMR effect sizes were consistent in direction. Results suggested that the causal pathways between eBMD and OA were bidirectional (βhip=1.10[0.36,1.84],p=0.003, β knee =4.16[2.74,5.57],p=8×10−9, β=SD increase per doubling in risk). MVMR identified a BMI-independent causal pathway between eBMD and hip/knee OA. LCV suggested that genetic correlation (i.e. shared genetic aetiology) did not fully explain causal effects of BMD on hip/knee OA.

Conclusions

These results provide evidence for a BMI-independent causal effect of eBMD on OA. Despite evidence of bidirectional effects, the effect of BMD on OA did not appear to be fully explained by shared genetic aetiology, suggesting a direct action of bone on joint deterioration.
Localised community circulation of SARS-CoV-2 viruses with an increased accumulation of single nucleotide polymorphisms that adversely affect the sensitivity of real-time reverse transcription assays targeting Nucleocapsid protein
Authors: Moore Catherine , Davies Louise , Rees Rhiannydd , Gifford Laura , Lewis Heather , Plimmer Amy , Barratt Andrew , Pacchiarini Nicole , Southgate Joel ,   the COG-UK Consortium, Bull Matthew J. , Watkins Joanne , Corden Sally , Connor Thomas R.
Published: March 2021

Currently the primary method for confirming acute SARS-CoV-2 infection is through the use of molecular assays that target highly conserved regions within the viral genome. Many, if not most of the diagnostic targets currently in use were produced early in the pandemic, using genomes sequenced and shared in early 2020. As viral diversity increases, mutations may arise in diagnostic target sites that have an impact on the performance of diagnostic tests. Here, we report on a local outbreak of SARS-CoV-2 which had gained an additional mutation at position 28890 of the nucleocapsid protein, on a background of pre-existing mutations at positions 28881, 28882, 28883 in one of the main circulating viral lineages in Wales at that time. The impact of this additional mutation had a statistically significant impact on the Ct value reported for the N gene target designed by the Chinese CDC and used in a number of commercial diagnostic products. Further investigation identified that, in viral genomes sequenced from Wales over the summer of 2020, the N gene had a higher rate of mutations in diagnostic target sites than other targets, with 115 issues identified affecting over 10% of all cases sequenced between February and the end of August 2020. In comparison an issue was identified for ORFab, the next most affected target, in less than 1.4% of cases over the same time period. This work emphasises the potential impact that mutations in diagnostic target sites can have on tracking local outbreaks, as well as demonstrating the value of genomics as a routine tool for identifying and explaining potential diagnostic primer issues as part of a laboratory quality management system. This work also indicates that with increasing genomic sequencing data availability, there is a need to re-evaluate the diagnostic targets that are in use for SARS-CoV-2 testing, to better target regions that are now demonstrated to be of lower variability.
Racial/ethnic disparities in sleep in mothers and infants during the Covid-19 pandemic
Authors: Lucchini Maristella , Kyle Margaret , Pini Nicolò , Sania Ayesha , Babineau Vanessa , Firestein Morgan R. , Fernández Cristina R. , Shuffrey Lauren C. , Barbosa Jennifer R , Rodriguez Cynthia , Fifer William P. , Alcántara Carmela , Monk Catherine , Dumitriu Dani
Published: March 2021

Study Objectives

To quantify the association between race/ethnicity and maternal and infant self-reported sleep health at 4 months, exploring the role of maternal depression, stress and symptoms of trauma related to the COVID-19 pandemic as potential mediators.

Methods

Participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N=71 non-Hispanic White, N=14 African American (AA), N=113 Hispanic, N=40 other/declined). Data on infant sleep were collected at 4 months postpartum. A subset of 149 women also completed questionnaires assessing maternal mental health and sleep. Multivariable regressions were used to separately estimate associations of race/ethnicity and mental health with multiple sleep domains for infants and mothers adjusting for individual-level covariates.

Results

Compared to non-Hispanic White, Hispanic infants slept less at night (β=- 101.7±17.6, p<0.0001) and AA and Hispanic infants went to bed later (respectively β =1.9±0.6, p<0.0001, β=1.7±0.3, p<0.0001). Hispanic mothers were less likely to perceive infant sleep as a problem (β=1.0±0.3, p=0.006). Compared to non-Hispanic White mothers, Hispanic mothers reported worse maternal sleep latency (β=1.2±0.4, p=0.002), and efficiency (β=0.8±0.4, p=0.03), but better subjective sleep quality (β=-0.7±0.4, p=0.05), and less daytime dysfunction (β=-0.8±0.4, p=0.04). Maternal mental health scores were statistically significant predictors of multiple domains of maternal sleep but did not mediate the association between race/ethnicity and sleep.

Conclusions

Racial/ethnic disparities in maternal and infant sleep are observable at 4 months post-partum. Maternal stress, depression and symptoms of trauma related to the COVID-19 pandemic did not mediate these associations.
Differential effect of corticosteroid treatment on Influenza, SARS, MERS, and SARS-CoV-2 patients: A meta-analysis and systematic review
Authors: Ali Sobur , Uddin Salman Zahir , Dewan Md. Nayem , Moniruzzaman M , Kabir Mir Himayet , Islam Mohammad Rafiqul , Monir Hossain , Hossan Shanewaz , Nafiz Tanvir Noor , Rashid Rumana , Imran Khan Mohammad
Published: March 2021

Background

Corticosteroid has been used to manage inflammation caused by many diseases including respiratory viral infections. Many articles are available to support the good and bad side of this steroid use but remain inconclusive. To find some evidence about the safety of the drug, we investigated the effect of corticosteroids on the mortality of patients with respiratory viral infections including SARS-CoV-2, SARS, MERS, and Influenza.

Method

We searched articles in PubMed, Scopus, Cochrane, Medline, Google Scholar, and Web of Science records using keywords “corticosteroid” or “viral infection” or “patients” or “control study”. Mortality was the primary outcome.

Result

Our selected 24 studies involving 16633 patients were pooled in our meta-analysis. Corticosteroid use and overall mortality were not significantly associated (P=0.176), but in subgroup analysis, corticosteroid use was significantly associated with lower mortality in the case of SARS (P=0.003) but was not significantly associated with mortality for Influenza (H1N1) (P=0.260) and SARS-CoV-2 (P=0.554). Further analysis using study types of SARS-CoV-2, we found that corticosteroid use was not significantly associated with mortality in the case of retrospective cohort studies (P=0.256) but was significantly associated with lower mortality in the case of randomized control trials (P=0.005). Our findings uncover how the outcome of particular drug treatment for different diseases with comparable pathogenesis may not be similar and, RCTs are sometimes required for robust outcome data.

Conclusion

At the beginning of the COVID-19 pandemic, data of corticosteroid use from other viral infections along with COVID-19 observational and retrospective cohort studies created confusion of its effect, but randomized control trials showed that corticosteroid can be used to treat COVID-19 patients.
Identification of Genetically Related HCV Infections Among Self-Described Injecting Partnerships
Authors: Tully Damien C. , Hahn Judith A. , Bean David J. , Evans Jennifer L. , Morris Meghan D. , Page Kimberly , Allen Todd M.
Published: March 2021

Background

The current opioid epidemic across the United States has fueled a surge in the rate of new HCV infections among young persons who inject drugs (PWIDs). Paramount to interrupting transmission is targeting these high-risk populations and understanding the underlying network structures facilitating transmission within these communities.

Methods

Deep sequencing data were obtained for 52 participants from 32 injecting partnerships enrolled in the UFO Partner Study which is a prospective study of self-described injecting dyad partnerships from a large community-based study of HCV infection in young adult PWIDs from San Francisco. Phylogenetically linked transmission events were identified using traditional genetic-distance measures and viral deep sequence phylogenies reconstructed to determine the statistical support of inferences and the direction of transmission within partnerships.

Results

Using deep sequencing data, we found that 12 of 32 partnerships were genetically similar and clustered. Three additional phylogenetic clusters were found describing novel putative transmission links outside of the injecting relationship. Transmission direction was inferred correctly for five partnerships with the incorrect transmission direction inferred in more than 50% of cases. Notably, we observed that phylogenetic linkage was most often associated with a lower number of network partners and involvement in a sexual relationship.

Conclusions

Deep sequencing of HCV among self-described injecting partnerships demonstrates that the majority of transmission events originate from outside of the injecting partnership. Furthermore, these findings caution that phylogenetic methods may be unable to routinely infer the direction of transmission among PWIDs especially when transmission events occur in rapid succession within high-risk networks.

Deep sequencing of HCV from 32 self-described injecting partnerships revealed that only 37% were genetically similar and inferring the direction of transmission using phylogenetic tools is challenging as HCV transmission is complex and multifaceted.
Continuity of routine immunization programs in Canada during the COVID-19 pandemic
Authors: Sell Hannah , Assi Ali , Driedger S. Michelle , Dubé Eve , Gagneur Arnaud , Meyer Samantha B. , Robinson Joan , Sadarangani Manish , Tunis Matthew , MacDonald Shannon E.
Published: March 2021

Introduction

In Canada, the COVID-19 pandemic has interrupted many routine health services, placed additional strain on the health care system, and resulted in many Canadians being either unable or unwilling to attend routine immunization appointments. We sought to capture and synthesize information about changes to routine immunization programs in response to the pandemic and plans to catch-up any missed immunizations.

Methods

Provincial/territorial (P/T) public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics: how routine immunization delivery was affected during and after initial lockdown periods, plans to catch-up missed doses, and major challenges and achievements in continuing routine immunization programs. Data were coded and categorized according to common responses and descriptive analysis was performed.

Results

Interviews occurred with participants from 11 of 13 P/Ts. School immunization programs were reported to be most negatively affected by the pandemic (n=9). In the early pandemic period, infant, preschool, and maternal/prenatal programs were prioritized, with most P/Ts continuing these services with adaptations for COVID-19. After the initial lockdown period, all routine programs were continuing with adaptations in most P/Ts. Infant, preschool, and school programs were most often targeted for catch-up through measures such as appointment rebooking and making additional clinics and/or providers available. Major challenges included resource limitations (e.g., staff shortages, PPE shortages, limited infrastructure) (n=11), public health restrictions (n=8), and public hesitancy to attend appointments (n=5).

Conclusions

Canadian routine immunization programs faced some disruptions due to the COVID-19 pandemic, particularly the school, adult, and older adult programs. Further research is needed to determine the measurable impact of the pandemic on routine vaccine coverage levels.
Testing and Vaccination to Reduce the Impact of COVID-19 in Nursing Homes: An Agent-Based Approach
Authors: Gómez-Vázquez Jose Pablo , García Yury , Schmidt Alec J. , Martínez-López Beatriz , Nuño Miriam
Published: March 2021

Background

Efforts to protect residents in nursing homes involve non-pharmaceutical interventions, testing, and vaccine. We sought to quantify the effect of testing and vaccine strategies on the attack rate, length of the epidemic, and hospitalization.

Methods

We developed an agent-based model to simulate the dynamics of SARS-CoV-2 transmission in a nursing home with resident and staff agents. Interactions between 172 residents and 170 staff were assumed based on data from a nursing home in Los Angeles, CA. We simulated scenarios assuming different levels of non-pharmaceutical interventions, testing frequencies, and vaccine efficacy to block transmission.

Results

Under the hypothetical scenario of widespread SARS-CoV-2 in the community, 3-day testing frequency minimized the attack rate and the time to eradicate an outbreak. Prioritization of vaccine among staff or staff and residents minimized the cumulative number of infections and hospitalization, particularly in the scenario of high probability of an introduction. Reducing the probability of a virus introduction reduced the demand on testing and vaccine to reduce infections and hospitalizations.

Conclusions

Improving frequency of testing from 7-days to 3-days minimized the number of infections and hospitalizations, despite widespread community transmission. Vaccine prioritization of staff provides the best protection strategy, despite high risk of a virus introduction.
Characterizing the disproportionate burden of SARS-CoV-2 variants of concern among essential workers in the Greater Toronto Area, Canada
Authors: Chagla Zain , Ma Huiting , Sander Beate , Baral Stefan D. , Mishra Sharmistha
Published: March 2021

Importance

The emergence of SARS-CoV-2 Variants of Concern (VOC) across North America has been associated with concerns of increased COVID-19 transmission. Characterizing the distribution of VOCs can inform development of policies and programs to address the prevention needs of disproportionately affected communities.

Objective

We compared per-capita rates of COVID-19 cases (overall and VOC) from February 3, 2021 to March 10, 2021, across neighborhoods in the health regions of Toronto and Peel, Ontario, by proportion of the population working in essential services and income.

Design

Descriptive epidemiological analysis, integrating COVID-19 surveillance and census data. Per-capita daily epidemic curves were generated using 7-days rolling averages for cases and deaths. Cumulative per-capita rates were determined using census-reported population of each neighbourhood.

Setting

The study setting was the city of Toronto and the region of Peel (the City of Brampton, Mississauga, and Caledon), Canada’s largest cities with a combined population of 4.3 million. This area of Canada has had one of the highest incident rates of COVID-19 throughout the pandemic.

Participants

We used person-level data on laboratory-confirmed COVID-19 community cases (N=22,478) and census data for neighborhood-level attributes.

Exposures

We stratified neighbourhoods, i.e., dissemination areas which represent geographic areas of approximately 400-700 individuals, into tertiles by ranking the proportion of population in each neighbourhood working in essential services (health, trades, transport, equipment, manufacturing, utilities, sales, services, agriculture); and the per-person equivalent household income.

Main Outcome(s) and Measure(s)

The primary outcomes were laboratory-confirmed COVID-19 cases overall and VOC positives by neighbourhood.

Results

During the study period, VOC cases emerged faster in groups with lowest income (growth rate 43.8%, 34.6% and 21.6% by income tertile from lowest to highest), and most essential work (growth rate 18.4%, 30.8% and 50.8% by tertile from lowest tertile of essential workers to highest tertile of essential workers).

Conclusions and Relevance

The recent introduction of VOC in a large urban area has disproportionately affected neighbourhoods with the most essential workers and lowest income levels. Notably, this is consistent with the increased burden of non-VOC COVID-19 cases suggesting shared risk factors. To date, restrictive public health strategies have been of limited impact in these communities suggesting the need for complementary and well-specified supportive strategies to address disparities and overall incidence of both VOC and non-VOC COVID-19.
Feasibility and effectiveness of daily temperature screening to detect COVID-19 in a large public university setting
Authors: Facente Shelley N. , Hunter Lauren A. , Packel Laura J. , Li Yi , Harte Anna , Nicolette Guy , McDevitt Shana , Petersen Maya , Reingold Arthur L.
Published: March 2021

Background

Many persons with active SARS-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention. Regular temperature screening is nonetheless used in some settings, including University campuses, to reduce transmission potential. We evaluated the potential impact of this strategy using a prospective University-affiliated cohort.

Methods

Between June and August 2020, 2,912 participants were enrolled and tested for SARS-CoV-2 by PCR at least once (median: 3, range: 1-9). Participants reported temperature and symptoms daily via electronic survey using a previously owned or study-provided thermometer. We assessed feasibility and acceptability of daily temperature monitoring, calculated sensitivity and specificity of various fever-based strategies for restricting campus access to reduce transmission, and estimated the association between measured temperature and SARS-CoV-2 test positivity using a longitudinal binomial mixed model.

Results

Most participants (70.2%) did not initially have a thermometer for taking their temperature daily. Across 5481 total person months, the average daily completion rate of temperature values was 61.6% (IQR: 41.8%–86.2%). Sensitivity for SARS-CoV-2 ranged from 0% (95%CI 0–9.7%) to 40.5% (95%CI 25.6–56.7%) across all strategies for self-report of possible COVID-19 symptoms on day of specimen collection, with corresponding specificity of 99.9% (95%CI 99.8–100%) to 95.3% (95%CI 94.7–95.9%). An increase of 0.1°F in individual mean body temperature on the same day as specimen collection was associated with 1.11 increased odds of SARS-CoV-2 positivity (95%CI 1.06–1.17).

Conclusions

Daily temperature monitoring was feasible and acceptable; however, the majority of potentially infectious individuals were not detected by temperature monitoring, suggesting that temperature screening is insufficient as a primary means of detection to reduce transmission of SARS-CoV-2.
Saliva testing as a means to monitor therapeutic lithium levels in patients
with psychiatric disorders: identification of clinical and environmental
covariates, and their incorporation into a prediction model
Authors: Parkin Georgia M. , McCarthy Michael J. , Thein Soe H. , Piccerillo Hillary L. , Warikoo Nisha , Granger Douglas A. , Thomas Elizabeth A.
Published: March 2021

The narrow therapeutic window of lithium medications necessitates frequent
serum monitoring, which can be expensive and inconvenient for the patient. The
use of saliva as a biofluid may have advantages over blood, as it is
non-invasive, easier to collect, requires less processing, and can be collected
without the need for trained personnel. This study investigated the utility of
saliva as a longitudinal means of monitoring lithium levels. We measured lithium
levels using Inductively-Coupled Plasma Optical Emission Spectrometry (ICP-OES)
in n=171 saliva samples collected via the passive drool method, from a
multi-center cohort consisting of n=75 patients with bipolar disorder or other
psychiatric conditions. We found that saliva and serum levels of lithium were
highly correlated (unadjusted Spearman r=0.74,
p<0.0001) and that consideration of daily lithium
dose, dosing schedule, cotinine-confirmed smoking status and diabetes status
could improve this relationship (adjusted Spearman r=0.77,
p<0.0001). Using this adjusted intersubject
equation to predict an individual’s serum lithium levels from their salivary
lithium value, we observed a strong linear correlation between the predicted vs.
actual serum lithium levels r=0.70; P<0.0001). Longitudinal samples were
collected from patients for up to 18 months from the initial assessment. The
saliva/serum ratios across these multiple visits were highly stable for most
patients. Variability in the saliva/serum ratios across observations was found
to be significantly associated with age. Using the intrasubject saliva/serum
ratio from a single prior observation was not better than using the interpatient
linear regression equation at predicting the serum lithium levels. However, the
using the mean intrasubject ratio calculated from three prior observations could
robustly predict serum levels with a predicted vs. actual serum correlation of
r=0.90 (p<0.0001). These findings strongly suggest
that saliva could be used for lithium monitoring and open the door for the
development and implementation of a point-of-care salivary lithium device that
could be used at home or in the clinic. We propose that the use of saliva will
dramatically improve treatment opportunities for patients with mood
disorders.

Data availability statement

Anonymized summary data will be shared by reasonable formal request from
qualified researchers, subject to a data sharing agreement and in compliance
with the requirements of the funding bodies and institutions.
Red flags useful to screen for gastrointestinal and hepatic diseases in patients with shoulder pain: a scoping review protocol
Authors: Roncone A , Fiorentino F , Pennella D , Maselli F , Brindisino F , Giagio S
Published: March 2021

Shoulder pain (SP) is the third most common musculoskeletal disorder worldwide and its prevalence ranges from 5 to 47%.

However, the clinical presentation of signs and symptoms may hide other serious conditions; the so-called Red Flags (RFs).

For these reasons, clinicians dealing with neuro-musculoskeletal shoulder disorders should pay particular attention during the medical history and clinical examination screening and identifying signs that may cause probable referred symptoms.

Considering the variety of clinical presentations of SP and the importance of the screening for referral, identifying and summarizing the possible gastrointestinal and hepatic diseases among these patients may give a comprehensive overview to the clinicians and consequently may improve the overall management.

To the authors knowledge, there are no published studies on the topic and, in this context, a scoping review is strongly required and corresponded to the objectives of this project.
Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center
Authors: Schaad Siméon , Brahier Thomas , Hartley Mary-Anne , Cordonnier Jean-Baptiste , Bosso Luca , Espejo Tanguy , Pantet Olivier , Hugli Olivier , Carron Pierre-Nicolas , Meuwly Jean-Yves , Boillat-Blanco Noémie
Published: March 2021

Background

Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening.

Methods

This prospective observational cohort included adults presenting with cough and/or dyspnea at a SARS-CoV-2 screening center of Lausanne University Hospital between March 31st and May 8th, 2020. Investigators recorded standardized LUS images and videos in 10 lung zones per subject. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to pre-specified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVIDpos vs COVIDneg). We finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score.

Results

Of 134 included patients, 23% (n=30/134) were COVIDpos and 77% (n=103/134) were COVIDneg; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2 to 5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVIDpos compared to COVIDneg (45% versus 26%, p=0.045) and mostly consisted of focal pathologic B-lines. Combining LUS findings in a multivariate logistic regression score had an area under the receiver-operating curve of 63.9% to detect COVID-19, but improved to 84.5% with the addition of clinical features

Conclusions

COVIDpos patients are significantly more likely to have lung pathology by LUS. Our findings have potential diagnostic value for COVID-19 at the point of care. Combination of clinical and LUS features showed promising results, which need confirmation in a larger study population.

What is already known on the subject

Lung ultrasonography (LUS) is a consumable-free, easy-to-use, portable, non-radiating and non-invasive screening tool that can be performed at the bedside: its diagnostic performance for pneumonia has been established.

Recent studies conducted in emergency department showed a correlation between LUS findings and COVID-19 diagnosis.

What the study ads

This is the first study assessing the diagnostic performance of LUS for COVID-19 in outpatients with mild acute respiratory tract infection.

Mild COVID-19 patients are more likely to have lung pathology by LUS compared with COVID-19 negative.

Combination of clinical and LUS features showed promising results with a potential diagnostic value for COVID-19 at the point of care.