bluuebunny/crossref_metadata_2025 huggingface dataset:
Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients
Authors: Pasrija Chetan , Sawan Mariem A. , Sorensen Erik , Voorhees Hannah Joy , Shah Aakash , Wang Libin , Ton Van-Khue , DiChiacchio Laura , Kaczorowski David J. , Griffith Bartley P. , Pham Si M. , Kon Zachary N.
Published: May 2020

Objective

Despite improvement in outcomes after left ventricular assist device (LVAD) implantation over the past 2 decades, high-risk recipients continue to have a prohibitive rate of morbidity and mortality. We hypothesized that a less invasive approach to LVAD implantation would be associated with improved survival compared to a conventional approach in this high-risk cohort.

Methods

All consecutive LVAD recipients (2013 to 2017) that underwent centrifugal LVAD implantation were retrospectively reviewed. Patients were classified as high-risk if INTERMACS 1 or required temporary VAD/venoarterial extracorporeal membrane oxygenation prior to durable VAD implantation. Patients were stratified into 3 groups: left thoracotomy with hemi-sternotomy (LTHS) high-risk, conventional sternotomy (CS) high-risk, and non-high-risk. The primary outcome was 1-year survival.

Results

A total of 57 patients (LTHS high-risk: 11, CS high-risk: 12, non-high-risk: 34) were identified. Preoperative right ventricular failure scores, HeartMate-II mortality scores, and end-organ dysfunction were similar between the 2 high-risk groups. While operative time was similar between the 3 groups, cardiopulmonary bypass time was significantly shorter in the LTHS high-risk group compared to other groups. There was a trend toward decreased intensive care unit length of stay and ventilator time in LTHS high-risk compared to CS high-risk patients. Moreover, between these 2 groups, there was a significant decrease in temporary right VAD support (50% vs 0%, P = 0.014), and 1-year survival was significantly higher in the LTHS group (42% vs 91%, P = 0.025).

Conclusions

Less invasive LVAD implantation appears to be associated with improved survival compared to conventional LVAD implantation in high-risk patients.
The economic burden of inpatient diabetic foot ulcers in Toronto, Canada
Authors: Syed Muzammil H , Salata Konrad , Hussain Mohamad A , Zamzam Abdelrahman , de Mestral Charles , Wheatcroft Mark , Harlock John , Awartani Deana , Aljabri Badr , Verma Amol , Razak Fahad , Verma Subodh , Al-Omran Mohammed
Published: May 2020

Objective

Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care.

Methods

We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses.

Results

Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14–1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17–1.34). Propensity-scored matched analyses confirmed these results.

Conclusion

Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.
Understanding the ideological construction of the Gulf crisis in Arab media discourse: A critical discourse analytic study of the headlines of Al Arabiya English and Al Jazeera English
Authors: Kharbach Mohamed
Published: May 2020

This article investigates the ideologisation of Arab media discourse and takes as a case in point the ideological construction of the Gulf crisis in the headlines of Al Arabiya English and Al Jazeera English. A corpus of 515 headlines produced between May and June 2017 is examined using an interdisciplinary critical discourse analytic framework. Analysis is conducted at two levels: a textual level concerned with the analysis of the semantic and syntactic aspects of headlines and a socio-cognitive level informed by insights from Van Dijk’s ideological square concept and his mental model theory and Laclau and Mouffe’s discourse theory. Findings indicate that both platforms are ideologically biased toward the political perspectives of their host states, although in a lesser degree in Al Jazeera English, and also reveal the various discursive strategies used to construct subjective mental models and reference frames to guide readers understanding of the crisis.
Development of finite element model for embedded carbon fiber–reinforced polymer rod in reinforced concrete frame joints
Authors: Basim Shahnaz , Hejazi Farzad , Muhammad Rashid Raizal Saifulnaz Bin , Hafezolghorani Esfahani Milad
Published: May 2020

The stiffness and strength of joints are the main factors in providing stability and ductility of a structure during dynamic load such as earthquake. In the high-humidity areas, the reinforcement is exposed to corrosion, which commonly occurs in the joints, due to the presence of micro-cracks in the joints, shrinkage or other concrete casting issues. Therefore, one of the main failure mechanisms of building during an earthquake is caused by damage in the joints in humid areas. This is mainly caused by corroded steel reinforcement, which reduces functionality of the frame joints in transferring the loads. This study proposes a new design for reinforced beam–column joints with embedded carbon fiber–reinforced polymer rods, which possesses extremely high strength and resistance against corrosion and high stiffness. The finite element model for embedded carbon fiber–reinforced polymer in the joints was developed in order to evaluate the performance of the proposed joints during earthquake execution. The developed program was verified through an experimental test on reinforced concrete frame subjected to vibration using dynamic actuator. The finite element program was implemented for one-story reinforced concrete frame and two-story frame building with proposed joints and seismic analysis. The results demonstrated a significant improvement in the performance of the frames reinforced with embedded carbon fiber–reinforced polymer in joints in terms of lateral load resistance capacity and failure mechanism.
Workload-indexed blood pressure response to a maximum exercise test among professional indoor athletes
Authors: Bauer Pascal , Kraushaar Lutz , Dörr Oliver , Nef Holger , Hamm Christian W , Most Astrid
Published: May 2020

Background

Exercise testing is performed regularly in professional athletes. However, the blood pressure response (BPR) to exercise is rarely investigated in this cohort, and normative upper thresholds are lacking. Recently, a workload-indexed BPR (increase in systolic blood pressure per increase in metabolic equivalent of task (SBP/MET slope)) was evaluated in a general population and was compared with mortality. We sought to evaluate the SBP/MET slope in professional athletes and compare it with performance.

Design

This was a cross-sectional study.

Methods

A total of 142 male professional indoor athletes (age 26 ± 5 years) were examined. Blood pressure was measured at rest and during a standardized, graded cycle ergometer test. We assessed the BPR during exercise, the workload, and the metabolic equivalent of task (MET). Athletes were divided into groups according to their SBP/MET slope quartiles (I <4.3; II 4.3–6.2; III >6.2–9; IV >9 mmHg/MET) and compared regarding systolic BP (sBP) and workload achieved.

Results

Athletes in group I (n = 42) had the lowest maximum sBP (180 ± 13 mmHg) but achieved the highest relative workload (4.2 ± 1 W/kg). With increasing SBP/MET slope, the maximum sBP increased (II (n = 56): 195 ± 15 mmHg; III (n = 44): 216 ± 16 mmHg) and the workload achieved decreased (II: 3.9 ± 0.7 W/kg; III: 3.3 ± 0.5 W/kg). The differences in sBP between these groups were significant (p < 0.001). None of the athletes were assigned to group IV (>9 mmHg/MET).

Conclusion

Athletes in the lowest SBP/MET slope quartile displayed the lowest maximum sBP but achieved a higher workload than athletes classified into the other SBP/MET slope groups. This simple, novel metric might help to distinguish a normal from an exaggerated BPR to exercise, to identify athletes at risk of developing hypertension.
Covid-19: implications for prehospital, emergency and hospital care in patients with acute coronary syndromes
Authors: Huber Kurt , Goldstein Patrick
Published: May 2020

Hospitals play a critical role in providing communities with essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to a rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the healthcare system at large. Planning during the community outbreak of coronavirus disease 2019 (Covid-19) is critical for maintaining healthcare services during our response. This paper describes, besides general measures in times of a pandemic, also the necessary changes in the invasive diagnosis and treatment of patients presenting with different entities of acute coronary syndromes including structural adaptations (networks, spokes and hub centres) and therapeutic adjustments.
Antiretroviral adherence for adolescents growing up with HIV: understanding real life, drug delivery and forgiveness
Authors: Foster Caroline , Ayers Sara , Fidler Sarah
Published: May 2020

Poorer adherence to medication is normal in adolescence and is one of a range of risk-taking behaviours common during a developmental stage that encompasses enormous cognitive, physical, sexual, social and emotional change. For adolescents living with human immunodeficiency virus (HIV) infection, poor adherence to antiretroviral therapy (ART) confers two significant challenges: poor health, but also the specific additional burden of onward transmission to partners. Late adolescence (15–19 years) is the only age group where HIV-associated mortality is rising, driven by poor adherence to ART and lack of access to second-line therapy, particularly amongst surviving perinatally infected young people. A previous lack of well-powered randomised multimodal behavioural ART adherence interventions specifically targeting adolescents is now being addressed and ongoing studies registered to ClinicalTrials.gov are described in the context of previous data. Accepting that despite enhanced support, some adolescents will continue to struggle with adherence, we must address how best to use existing ART agents to reduce mortality and allow adolescents the time to mature into adult life. Single-tablet regimens with a high genetic barrier to resistance based on integrase inhibitors and boosted protease inhibitors exist, but global access, in resource limited settings of young people living with HIV reside, is limited. Pragmatically, such regimens tolerate the intermittent adherence so characteristic of adolescence, preserving immune function, without the rapid evolution of resistance. The potential role of long-acting injectable ART, specifically cabotegravir and rilpivirine, is discussed and future strategies including ultra-long-acting drug-delivery systems and broadly neutralising monoclonal antibodies explored.
Childhood hearing impairment and its associated factors in sub-Saharan Africa in the 21st century: A systematic review and meta-analysis
Authors: Desalew Assefa , Feto Gelano Tilayie , Semahegn Agumasie , Geda Biftu , Ali Tilahun
Published: May 2020

Background:

Childhood hearing impairment is still a significant cause of disability in the 21st century in developing countries. Particularly, the burden is more severe in sub-Saharan Africa, where the majority of children with hearing problems is living. Thre are great variations and inconsistencies of available findings conducted in sub-Saharan Africa. Hence, the aim of this review was to determine the pooled prevalence of childhood hearing impairment and its associated factors in sub-Saharan Africa.

Methods:

Studies were searched from main databases (PubMed, CINAHL, and African Journals Online), Google Scholar, and other relevant sources using electronic and manual techniques. All observational studies, written in English and conducted among participants (aged less than 18 years) from 2000 to 2018, were eligible. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of the funnel plot. Statistical analysis was carried out to determine pooled prevalence using Stata version 14. In addition, subgroup analysis was carried out for the normality criteria of hearing thresholds and characteristics of the study populations.

Results:

The pooled prevalence of hearing impairment was 10% (95% confidence interval (CI): 9%–11%). The magnitude of hearing impairment varies with the normality criterion used. The most commonly used threshold was 25 and 30 dB hearing level. The prevalence of hearing impairment based on normality criterion (>20 dB, >25 dB, >30 dB, and >35 dB) were 17%, 19%, 2%, and 1%, respectively. While in the questionnaire-based evaluation, the prevalence was 6% (95% CI: 3%–9%). In addition, based on population characteristics, the prevalence of hearing impairment for school or community-based children was 6% (95% CI: 5%–7%) while the prevalence for children with comorbidities was 23% (95% CI: 15%–31%). Chronic suppurative otitis media, impacted cerumen, advanced stage of human immunodeficiency virus, tuberculosis infection, and age of the children were associated with hearing impairment in sub-Saharan Africa.

Conclusion:

Hearing impairment in children and adolescents in sub-Saharan Africa was high, and associated with preventable and treatable risk factors.
Optimising patients with long-term spinal cord injury for nephrectomy: A review of pre-, peri- and post-operative factors to safeguard outcomes
Authors: Donati-Bourne J , Kasmani Z , Mohamed WGE , Pillai P , O’Dair J , Bhatt RI
Published: May 2020

Objectives:

To review the potential challenges a urologist may encounter when embarking on simple/partial/radical nephrectomy in patients with long-term spinal cord injury and propose strategies to pre-empt and manage these.

Materials and methods:

Comprehensive literature review via PubMed, MEDLINE® and Google™ Scholar searching for relevant scientific articles published to date in English. Recommendations for strategies to safeguard surgical outcomes discussed with a panel of experienced upper-tract urologists.

Results:

Pre-operative considerations:  - urethral assessment via flexible cystoscopy due to higher incidence of urethral pathology in spinal cord injury;  - assessing for chronic constipation and distended bowel; and  - considering glomerular filtration rate assessment by radio-isotope techniques, such as 51chromium-EDTA Peri-operative considerations:  - adequate theatre staffing for safe patient transfer; and  - planned choice of incision, due to higher incidence of previous abdominal surgery, stoma bags and/or foreign body devices. Post-operative considerations:  - ensuring attending medical staff are trained to recognise autonomic dysreflexia;  - early re-mobilisation with physiotherapists experienced in treating spinal cord injury; and  - attentive antibiotic stewardship due to higher risk of hospital-acquired or urinary infections

Conclusions:

Patients with long-term spinal cord injury pose significant potential challenges in the pre-, peri- and post-operative stages of nephrectomy. Familiarisation and optimisation of such factors is recommended to safeguard outcomes.

Level of evidence:

Not applicable for this multicentre audit.
Real Talk About Fake News: Identity Language and Disconnected Networks of the US Public’s “Fake News” Discourse on Twitter
Authors: Li Jianing , Su Min-Hsin
Published: May 2020

This article studies “fake news” beyond the consumption and dissemination of misinformation and disinformation. We uncover how the term “fake news” serves as a discursive device for ordinary citizens to consolidate group identity in everyday political utterances on Twitter. Using computational linguistic and network analyses, we demonstrate that over the period of 2016–2018, there is an uptrend in the use of identity language in US Twitter users’ discussions about “fake news,” manifested by the increased frequency of group pronouns in combination with issues and sentiments that boost one’s ingroup and derogate the outgroup. Furthermore, as opposed to the conventional wisdom that “fake news” is a right-wing term, we uncover two disconnected retweet networks surrounding liberal and conservative opinion leaders. Like-minded individuals selectively amplify ingroup messages to claim the power to define falsehood and make group-serving blame attributions. We discuss the theoretical implications of our findings and offer new directions for future research on “fake news,” misinformation, and disinformation.
An evaluation of the impact of attachment and trauma training for pupil referral unit staff
Authors: Greenhalgh Rebecca , Fflur Siana , Donnelly Katherine , Kirkaldie Helen , McDonnell Lynn
Published: May 2020

Background:

The Gwent Attachment Service trained four pupil referral units (PRUs) staff in attachment- and trauma-informed work. Education staff received 2 days of training and then attended six skills development sessions (SDSs) on a monthly basis to embed the training concepts into their work. This model takes a “whole systems approach” to intervention, drawing on evidence suggesting that having a supportive and consistent system around a child that takes into account their attachment needs leads to better outcomes.

Methods:

Self-reported knowledge of attachment- and trauma-informed work, confidence in carrying out this work, and worries about implementing this work were collected from 64 education staff members across the four PRUs. Measures were repeated at three time points: pre-training, post-training, and post-SDS.

Results:

Knowledge and confidence increased from pre- to post-training. Knowledge did not significantly differ between post-training and post-SDS. Confidence was lower at post-SDS than post-training but remained above pre-training ratings. Worries decreased from pre- to post-training and decreased again post-SDS.

Conclusion:

Training and SDSs can improve teaching staffs’ perception of their knowledge and confidence, while reducing worries about working in an attachment- and trauma-informed way. SDSs decreased worries about working in an attachment- and trauma-informed way over and above training alone, indicating that the SDSs contribute added value. This study presents a promising starting point for improving the lives of children and young people who have experienced trauma and have attachment difficulties.
A Didactic Lecture Is Effective in Teaching Sonographers the TI-RADS System for Stratifying Thyroid Nodules
Authors: Patel Vishal , Roberts Jeffrey , Cohen Bruce , Frank Susan , Fine Rona Orentlicher , Rosenblum Jessica , Koenigsberg Mordecai , Stein Marjorie
Published: May 2020

Objective:

The aim of this study is to determine whether a one-hour image-rich didactic lecture given to sonographers can successfully teach them the TI-RADS (Thyroid Imaging, Reporting and Data System) lexicon, to improve their recognition of malignant thyroid nodules.

Methods:

A one-hour image-rich didactic lecture on TI-RADS was designed that encompassed the diagnostic criteria for thyroid malignancy and technical tips to better demonstrate thyroid nodules. A lecture was presented to 34 sonographers across multiple sites. The study examined the effects of the lecture by comparing the results of a pretest, an immediate posttest, and a two-week delayed posttest.

Results:

All 34 sonographers participated in the lecture intervention and each assessment. The prelecture assessment scores ranged from 13% to 73% with an average of 46%. Immediately after the lecture, the assessment scores ranged from 27% to 100%, with an average of 77%. Two weeks after the lectures, scores ranged from 27% to 93%, with an average of 70%. Compared to the pretest, there was a statistically significant increase in average scores immediately after and two weeks after the lecture.

Conclusion:

It is critically importance to have a reliable, noninvasive method to identify thyroid nodules that have a greater chance of malignancy. A didactic lecture could successfully teach, result in knowledge retention, and increase sonographers’ confidence in the TI-RADS lexicon.
Results from the European Union MAPEC_LIFE cohort study on air pollution and chromosomal damage in children: are public health policies sufficiently protective?
Authors:   MAPEC_LIFE Study Group, Ceretti Elisabetta , Donato Francesco , Zani Claudia , Villarini Milena , Verani Marco , De Donno Antonella , Bonetta Sara , Feretti Donatella , Carducci Annalaura , Idolo Adele , Carraro Elisabetta , Covolo Loredana , Moretti Massimo , Palomba Giacomo , Grassi Tiziana , Bonetti Alberto , Bonizzoni Silvia , Biggeri Annibale , Gelatti Umberto
Published: May 2020

Background

Children are at high risk of suffering health consequences of air pollution and childhood exposure can increase the risk of developing chronic diseases in adulthood. This study, part of the MAPEC_LIFE project (LIFE12 ENV/IT/000614), aimed to investigate the associations between exposure to urban air pollutants and micronucleus (MN) frequency, as a biomarker of chromosomal damage, in buccal cells of children for supporting implementation and updating of environmental policy and legislation.

Methods

This prospective epidemiological cohort study was carried out on 6- to 8-year-old children living in five Italian towns with different levels and features of air pollution. Exfoliated buccal cells of the children were sampled twice, in winter and spring, obtaining 2139 biological samples for genotoxicological investigation. Micronucleus (MN) frequency was investigated in buccal cells of children and its association with air pollution exposure was assessed applying multiple Poisson regression mixed models, including socio-demographic and lifestyle factors as confounders. We also dichotomize air pollutants’ concentration according to the EU Ambient Air Quality Directives and WHO Air Quality Guidelines in all Poisson regression models to assess their risk predictive capacity.

Results

Positive and statistically significant associations were found between MN frequency and PM10, PM2.5, benzene, SO2 and ozone. The increment of the risk of having MN in buccal cells for each μg/m3 increase of pollutant concentration was maximum for benzene (18.9%, 95% CIs 2.2–38.4%) and modest for the other pollutants (between 0.2 and 1.4%). An increased risk (between 17.9% and 59.8%) was found also for exposure to PM10, benzene and benzo(a)pyrene levels higher than the threshold limits.

Conclusions

Some air pollutants are able to induce chromosomal damage in buccal cells of children even at concentrations below present EU/WHO limits. This type of biological effects may be indicative of the environmental pressure which populations are exposed to in urban areas.
Comparative genomics of whole-cell pertussis vaccine strains from India
Authors: Alai Shweta , Ghattargi Vikas C. , Gautam Manish , Patel Krunal , Pawar Shrikant P. , Dhotre Dhiraj P. , Shaligram Umesh , Gairola Sunil
Published: May 2020

Background

Despite high vaccination coverage using acellular (ACV) and whole-cell pertussis (WCV) vaccines, the resurgence of pertussis is observed globally. Genetic divergence in circulating strains of Bordetella pertussis has been reported as one of the contributing factors for the resurgence of the disease. Our current knowledge of B. pertussis genetic evolution in circulating strains is mostly based on studies conducted in countries using ACVs targeting only a few antigens used in the production of ACVs. To better understand the adaptation to vaccine-induced selection pressure, it will be essential to study B. pertussis populations in developing countries which are using WCVs. India is a significant user and global supplier of WCVs. We report here comparative genome analyses of vaccine and clinical isolates reported from India. Whole-genome sequences obtained from vaccine strains: WCV (J445, J446, J447 and J448), ACV (BP165) were compared with Tohama-I reference strain and recently reported clinical isolates from India (BPD1, BPD2). Core genome-based phylogenetic analysis was also performed using 166 isolates reported from countries using ACV.

Results

Whole-genome analysis of vaccine and clinical isolates reported from India revealed high genetic similarity and conserved genome among strains. Phylogenetic analysis showed that clinical and vaccine strains share genetic closeness with reference strain Tohama-I. The allelic profile of vaccine strains (J445:ptxP1/ptxA2/prn1/fim2–1/fim3–1; J446: ptxP2/ptxA4/prn7/fim2–2/fim3–1; J447 and J448: ptxP1/ptxA1/ prn1/fim2–1/fim3–1), which matched entirely with clinical isolates (BPD1:ptxP1/ptxA1/prn1/fim2–1 and BPD2: ptxP1/ptxA1/prn1/fim2–1) reported from India. Multi-locus sequence typing (MLST) demonstrated the presence of dominant sequence types ST2 and primitive ST1 in vaccine strains which will allow better coverage against circulating strains of B. pertussis.

Conclusions

The study provides a detailed characterization of vaccine and clinical strains reported from India, which will further facilitate epidemiological studies on genetic shifts in countries which are using WCVs in their immunization programs.
In-depth analysis of T2Bacteria positive results in patients with concurrent negative blood culture: a case series
Authors: Kalligeros Markos , Zacharioudakis Ioannis M. , Tansarli Giannoula S. , Tori Katerina , Shehadeh Fadi , Mylonakis Eleftherios
Published: May 2020

Background

T2Bacteria assay uses T2 magnetic resonance (T2MR) technology for the rapid diagnosis of bacterial bloodstream infections (BSIs). This FDA cleared technology can detect 5 of the most prevalent pathogens causing bacteremia (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecium). Because the significance of discordant results between the T2Bacteria assay and blood culture (BC) remains a challenge, in this case series we reviewed the medical records of patients who had a positive T2Bacteria test and a concurrent negative BC.

Methods

Among 233 participants, we identified 20 patients with 21 (9%) discordant T2Bacteria-positive/BC-negative (T2+/BC-) results. We classified these results based on clinical cultures and clinical evidence.

Results

When we analyzed these 21 discordant results in-depth, 11 (52.5%) fulfilled criteria for probable BSI, 4 (19%) for possible BSI, and 6 (28.5%) were presumptive false positives. Among the probable/possible BSIs, discordant results were often associated with patients diagnosed with closed space and localized infections [pyelonephritis (n = 7), abscess (n = 4), pneumonia (n = 1), infected hematoma (n = 1), and osteomyelitis (n = 1)]. Also, within the preceding 2 days of the T2+/BC- blood sample, 80% (16/20) of the patients had received at least one dose of an antimicrobial agent which was active against the T2Bacteria-detected pathogen.

Conclusions

In the majority of discrepant results, the T2Bacteria assay detected a plausible pathogen that was supported by clinical and/or microbiologic data. Discrepancies appear to be associated with closed space and localized infections and the recent use of effective antibacterial agents. The clinical significance and potential implications of such discordant results should be further investigated.
A child with household transmitted COVID-19
Authors: Mao Li-juan , Xu Jian , Xu Zhi-hao , Xia Xiao-ping , Li Bin , He Jian-guo , Zhao Peng , Pan Jian-wei , Zhang Dan , Su Yue , Wang Yue-hong , Yuan Zhe-feng
Published: May 2020

Background

Although people of all ages are susceptible to the novel coronavirus infection, which is presently named “Coronavirus Disease 2019” (COVID-19), there has been relatively few cases reported among children. Therefore, it is necessary to understand the clinical characteristics of COVID-19 in children and the differences from adults.

Case presentation

We report one pediatric case of COVID-19. A 14-month-old boy was admitted to the hospital with a symptom of fever, and was diagnosed with a mild form of COVID-19. The child’s mother and grandmother also tested positive for SARS-CoV-2 RNA. However, the lymphocyte counts were normal. The chest computed tomography (CT) revealed scattered ground glass opacities in the right lower lobe close to the pleura and resorption after the treatment. The patient continued to test positive for SARS-CoV-2 RNA in the nasopharyngeal swabs and stool at 17 days after the disappearance of symptoms.

Conclusion

The present pediatric case of COVID-19 was acquired through household transmission, and the symptoms were mild. Lymphocyte counts did not significantly decrease. The RNA of SARS-CoV-2 in stool and nasopharyngeal swabs remained positive for an extended period of time after the disappearance of symptoms. This suggests that attention should be given to the potential contagiousness of pediatric COVID-19 cases after clinical recovery.
Sudden death in epilepsy and ectopic neurohypophysis in Joubert syndrome 23 diagnosed using SNVs/indels and structural variants pipelines on WGS data: a case report
Authors: Sumathipala Dulika , Strømme Petter , Gilissen Christian , Einarsen Ingunn Holm , Bjørndalen Hilde J. , Server Andrés , Corominas Jordi , Hassel Bjørnar , Fannemel Madeleine , Misceo Doriana , Frengen Eirik
Published: May 2020

Background

Joubert syndrome (JBTS) is a genetically heterogeneous group of neurodevelopmental syndromes caused by primary cilia dysfunction. Usually the neurological presentation starts with abnormal neonatal breathing followed by muscular hypotonia, psychomotor delay, and cerebellar ataxia. Cerebral MRI shows mid- and hindbrain anomalies including the molar tooth sign. We report a male patient with atypical presentation of Joubert syndrome type 23, thus expanding the phenotype.

Case presentation

Clinical features were consistent with JBTS already from infancy, yet the syndrome was not suspected before cerebral MRI later in childhood showed the characteristic molar tooth sign and ectopic neurohypophysis. From age 11 years seizures developed and after few years became increasingly difficult to treat, also related to inadequate compliance to therapy. He died at 23 years of sudden unexpected death in epilepsy (SUDEP). The genetic diagnosis remained elusive for many years, despite extensive genetic testing. We reached the genetic diagnosis by performing whole genome sequencing of the family trio and analyzing the data with the combination of one analysis pipeline for single nucleotide variants (SNVs)/indels and one for structural variants (SVs). This lead to the identification of the most common variant detected in patients with JBTS23 (OMIM# 616490), rs534542684, in compound heterozygosity with a 8.3 kb deletion in KIAA0586, not previously reported.

Conclusions

We describe for the first time ectopic neurohypophysis and SUDEP in JBTS23, expanding the phenotype of this condition and raising the attention on the possible severity of the epilepsy in this disease. We also highlight the diagnostic power of WGS, which efficiently detects SNVs/indels and in addition allows the identification of SVs.
Correction to: The urinary microbiome shows different bacterial genera in renal transplant recipients and non-transplant patients at time of acute kidney injury – a pilot study
Authors: Gerges-Knafl Daniela , Pichler Peter , Zimprich Alexander , Hotzy Christoph , Barousch Wolfgang , Lang Rita M. , Lobmeyr Elisabeth , Baumgartner-Parzer Sabina , Wagner Ludwig , Winnicki Wolfgang
Published: May 2020

An amendment to this paper has been published and can be accessed via the original article.
Postpartum visits in the gynecological emergency room: How can we improve?
Authors: Weissmann-Brenner Alina , Heusler Ishai , Manteka Renana , Dulitzky Mordechai , Baum Micha
Published: May 2020

Background

The attendance to the gynecological-emergency-room (GER) of women only a few weeks following previous discharge after birth comprises a medical as well as social problem. The objective of the study was to characterize the postpartum women that attended the GER, and depict the leading etiologies and risk-factors that lead them to attend the GER, and to examine correlations between their medical findings at discharge and the reasons for their attendance to the hospital.

Methods

All women that attended the GER between 01/01/2016 and 30/09/2016 during 6 weeks after birth were included. The variables assessed were: medical history, mode of birth, maternal complications of birth, diagnosis at the GER, treatment received and readmission.

Results

There were 446 visits of 413 women (5.6% of all deliveries). Most were generally healthy after their first normal vaginal birth with no complications during or following birth. 38.7% had a cesarean birth (p < 0.001). The most common causes of the visits were fever (30.3%), problems in episiotomy or surgical scar (26.6%) and abdominal pain (25.7%). Women with hypertensive disorders during birth had significantly more hypertensive problems in the GER. Diabetic women suffered statistically more from hypertensive disorder in the GER. 33.2% were examined and found healthy. Seventy-two women (1% of all deliveries) were hospitalized, most of them due to infection. Only 7.5% were referred to the GER due to bleeding.

Conclusions

Postpartum women are at risk of morbidities, especially following cesarean sections and in women with hypertensive disorders of during pregnancy. Scheduled visits to high-risk women to attend outpatient clinic sooner are recommended.
Dynamics of the bacterial gut microbiota in preterm and term infants after intravenous amoxicillin/ceftazidime treatment
Authors: Zwittink Romy D. , van Zoeren-Grobben Diny , Renes Ingrid B. , van Lingen Richard A. , Norbruis Obbe F. , Martin Rocio , Groot Jebbink Liesbeth J. , Knol Jan , Belzer Clara
Published: May 2020

Background

It is important to understand the consequences of pre-emptive antibiotic treatment in neonates, as disturbances in microbiota development during this key developmental time window might affect early and later life health outcomes. Despite increasing knowledge regarding the detrimental effect of antibiotics on the gut microbiota, limited research focussed on antibiotic treatment duration. We determined the effect of short and long amoxicillin/ceftazidime administration on gut microbiota development during the immediate postnatal life of preterm and term infants.

Methods

Faeces was collected from 63 (pre) term infants at postnatal weeks one, two, three, four and six. Infants received either no (control), short-term (ST) or long-term (LT) postpartum amoxicillin/ceftazidime treatment.

Results

Compared to control infants, ST and LT infants’ microbiota contained significantly higher abundance of Enterococcus during the first two postnatal weeks at the expense of Bifidobacterium and Streptococcus. Short and long antibiotic treatment both allowed for microbiota restoration within the first six postnatal weeks. However, Enterococcus and Bifidobacterium abundances were affected in fewer ST than LT infants.

Conclusions

Intravenous amoxicillin/ceftazidime administration affects intestinal microbiota composition by decreasing the relative abundance of Escherichia-Shigella and Streptococcus, while increasing the relative abundance of Enterococcus and Lactobacillus species during the first two postnatal weeks. Thriving of enterococci at the expense of bifidobacteria and streptococci should be considered as aspect of the cost-benefit determination for antibiotic prescription.
Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark
Authors: Larsen Ulla Lei , Jepsen Søren , Strøm Thomas , Qvist Niels , Toft Palle
Published: May 2020

Background

Between 1998 and 2015, we report on the survival of congenital diaphragmatic hernia (CDH)-infants presenting with symptoms within the first 24 h of life, treated at Odense University Hospital (OUH), a tertiary referral non-extracorporeal membrane oxygenation (ECMO) hospital for paediatric surgery.

Methods

We performed a retrospective cohort study of prospectively identified CDH-infants at our centre. Data from medical records and critical information systems were obtained. Baseline data included mode of delivery and infant condition. Outcome data included 24-h, 28-day, and 1 year mortality rates and management data included intensive care treatment, length of stay in the intensive care unit, time of discharge from hospital, and surgical intervention. Descriptive analyses were performed for all variables. Survivors and non-survivors were compared for baseline and treatment data.

Results

Ninety-five infants were identified (44% female). Of these, 77% were left-sided hernias, 52% were diagnosed prenatally, and 6.4% had concurrent malformations. The 28-day mortality rate was 21.1%, and the 1 year mortality rate was 22.1%. Of the 21 non-survivors, nine died within the first 24 h, and 10 were sufficiently stabilised to undergo surgery. A statistically significant difference was observed between survivors and non-survivors regarding APGAR score at 1 and 5 min., prenatal diagnosis, body length at birth, and delivery at OUH.

Conclusions

Our outcome results were comparable to published data from other centres, including centres using ECMO.
Correction to: Surfactant protein A as a biomarker of outcomes of anti-fibrotic drug therapy in patients with idiopathic pulmonary fibrosis
Authors: Yoshikawa Takumi , Otsuka Mitsuo , Chiba Hirofumi , Ikeda Kimiyuki , Mori Yuki , Umeda Yasuaki , Nishikiori Hirotaka , Kuronuma Koji , Takahashi Hiroki
Published: May 2020

Following publication of the original article [1], the authors have flagged that there is an error in Fig. 3.
CT differential diagnosis of COVID-19 and non-COVID-19 in symptomatic suspects: a practical scoring method
Authors: Luo Lin , Luo Zhendong , Jia Yizhen , Zhou Cuiping , He Jianlong , Lyu Jianxun , Shen Xinping
Published: May 2020

Background

Although typical and atypical CT image findings of COVID-19 are reported in current studies, the CT image features of COVID-19 overlap with those of viral pneumonia and other respiratory diseases. Hence, it is difficult to make an exclusive diagnosis.

Methods

Thirty confirmed cases of COVID-19 and forty-three cases of other aetiology or clinically confirmed non-COVID-19 in a general hospital were included. The clinical data including age, sex, exposure history, laboratory parameters and aetiological diagnosis of all patients were collected. Seven positive signs (posterior part/lower lobe predilection, bilateral involvement, rounded GGO, subpleural bandlike GGO, crazy-paving pattern, peripheral distribution, and GGO +/− consolidation) from significant COVID-19 CT image features and four negative signs (only one lobe involvement, only central distribution, tree-in-bud sign, and bronchial wall thickening) from other non-COVID-19 pneumonia were used. The scoring analysis of CT features was compared between the two groups (COVID-19 and non-COVID-19).

Results

Older age, symptoms of diarrhoea, exposure history related to Wuhan, and a lower white blood cell and lymphocyte count were significantly suggestive of COVID-19 rather than non-COVID-19 (p < 0.05). The receiver operating characteristic (ROC) curve of the combined CT image features analysis revealed that the area under the curve (AUC) of the scoring system was 0.854. These cut-off values yielded a sensitivity of 56.67% and a specificity of 95.35% for a score > 4, a sensitivity of 100% and a specificity of 23.26% for a score > 0, and a sensitivity of 86.67% and a specificity of 67.44% for a score >  2.

Conclusions

With a simple and practical scoring system based on CT imaging features, we can make a hierarchical diagnosis of COVID-19 and non-COVID-19 with different management suggestions.
Influence of KISS1 gene polymorphisms on the risk of polycystic ovary syndrome and its associated variables, in Saudi women
Authors: Daghestani Maha H. , Daghestani Mazin H. , Daghistani Mamoon , Ambreen Khushboo , Albalawi Fadwa S. , AlNeghery Lina M. , Warsy Arjumand S.
Published: May 2020

Background

Polycystic ovary syndrome (PCOS) is a complex multifactorial disorder, affecting millions of women worldwide. The role of genetic polymorphisms of the KISS1 gene on the development of PCOS is still obscure. This study was designed to investigate the probable influence of KISS1 gene polymorphisms on PCOS and its associated variables: BMI, waist-hip ratio, kisspeptin, LH, FSH, and LH-FSH ratio.

Methods

The study comprised 104 PCOS women and 109 controls, with age ranging from 19 to 36 years. BMI, waist-hip ratio, and circulating levels of kisspeptin, LH, and FSH were measured. DNA was extracted, and genotyping of the KISS1 gene was carried out by nucleotide sequencing. The PCOS-associated variables were analyzed in different genotypes of single nucleotide polymorphisms (SNPs) of the KISS1 gene.

Results

The values of waist-hip ratio (WHR), LH, and LH-FSH ratio were significantly higher in PCOS women than controls. BMI, kisspeptin, and FSH levels exhibited no significant difference between the groups. Six novel SNPs of KISS1 gene were identified. Three: rs372790354G > A, rs12998G > A, and rs35431622A > T were investigated. Among these SNPs, the genotype and allele frequencies of rs372790354 showed significant association with PCOS (GA: p = 0.018, AA: p = 0.022, mutant allele-A: p = 0.021) and the G allele was protective. The values of LH, kisspeptin, and WHR of PCOS women were significantly influenced (p < 0.05) by the AA genotype of rs372790354. The other two SNPs rs12998G > A and rs35431622A > T revealed no significant influence on PCOS and associated variables. Haplotypes were constructed, but there was no significant difference between the patients and controls.

Conclusion

In conclusion, this is the first study, which reports a significant influence of KISS1 gene polymorphism (rs372790354G > A) on PCOS and its associated variables. However, more extensive research is necessary to confirm these findings.
Role of community pharmacists in weight management: results of a national study in Lebanon
Authors: Hijazi Mohamad Ali , Shatila Hibeh , El-Lakany Abdalla , Al Rifai Hiba , Aboul-Ela Maha , Naja Farah
Published: May 2020

Background

Ideally situated within the community, pharmacists can be involved in a broad range of health promotion campaigns including prevention of obesity. Limited evidence is available regarding their involvement in weight management in Lebanon, a country with escalating prevalence rate of obesity.

Objective

To examine the role of community pharmacists in weight management in Lebanon, specifically studying their beliefs, current practices, services, and knowledge.

Methods

Using a stratified random sampling approach, a cross sectional national survey of community pharmacists was conducted (n = 341, response rate 89%). At the pharmacy, and through a face-to-face interview, pharmacists completed a multi-component questionnaire that addressed, in addition to socio-demographic and work characteristics, their beliefs, practices, knowledge in relation to weight management. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analyses were used to examine the determinants of knowledge in the study population.

Results

Over 80% of study participants agreed that they have an important role to play in weight management. However, 50% of pharmacists did not agree that weight loss products are well regulated and 81.1% thought that companies marketing weight loss products are making false promises. The majority of pharmacists always/often sold weight loss products (84.7%) and counseled their patients for diet (86.3%) and physical activity (91.7%). Despite taking weight and height measurements, 50% of pharmacists rarely/never calculated BMI. Among the pharmacists who reported side effects of weight loss products (46.5%), the majority (91.3%) did so to the pharmaceutical company. The knowledge of pharmacists was better for the use of weight loss products as opposed to their side effects and interactions. Significant predictors of knowledge were holding a Masters/ PhD degree in Pharmacy, graduating from a university inside Lebanon, obtaining weight management training within the academic degree, and receiving inquiries about weight management in the pharmacy more than once daily.

Conclusions

The results of the study provided important insights on the beliefs, practices and knowledge of community pharmacists in weight management in Lebanon. These findings could be used to inform the development of future evidence-based community pharmacists led weight management service provision nationally and internationally.
Xp11.22 duplications in four unrelated Chinese families: delineating the genotype-phenotype relationship for HSD17B10 and FGD1
Authors: Wang Qingming , Chen Pengliang , Liu Jianxin , Lou Jiwu , Liu Yanhui , Yuan Haiming
Published: May 2020

Background

Xp11.22 duplications have been reported to contribute to nonsyndromic intellectual disability (ID). The HUWE1 gene has been identified in all male Xp11.22 duplication patients and is associated with nonsyndromic ID. Currently, few Xp11.22 duplication cases have been reported in the Chinese population, with limited knowledge regarding the role of other genes in this interval.

Case presentation

We investigated four unrelated Chinese male Xp11.22 duplication patients, performed a comprehensive clinical evaluation for the patients and discussed the role of other genes in this interval. All patients presented with similar clinical features, including ID, speech impairments and motor delay, which were mostly consistent with those of the Xp11.22 duplication described previously. We searched and compared all cases and noted that one of the probands (Family 1) and DECIPHER case 263,219, who carried small overlapping duplications at Xp11.22 that only covered the entire HSD17B10 gene, also suffered from ID, suggesting the important role of HSD17B10 in this interval. Furthermore, three patients (two probands in Families 3 and 4 and DECIPHER case 249,490) had strikingly similar hypogonadism phenotypes, including micropenis, small testes and cryptorchidism, which have not been previously described in Xp11.22 duplication patients. Interestingly, the FGD1 gene was duplicated only in these three patients. Sufficient evidence has suggested that haploinsufficiency of the FGD1 gene causes Aarskog-Scott syndrome, which is characterized by hypogonadism and other abnormalities. Given that, we are the first group to propose that FGD1 may be a potential dosage-sensitive gene responsible for the hypogonadism observed in our patients.

Conclusion

We reported novel genotypes and phenotypes in Chinese male Xp11.22 duplication patients, and the HSD17B10 and FGD1 genes may be involved.