bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations Between Socioeconomic Status, Patient Risk, and Short-Term Intensive Care Outcomes
Authors: Mullany Daniel V. , Pilcher David V. , Dobson Annette J.
Published: April 2021

OBJECTIVES:

To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia.

DESIGN:

Secondary data analysis using de-identified data from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation linked to the publicly available area-level Index of Relative Socioeconomic Advantage and Disadvantage from the Australian Bureau of Statistics.

SETTING:

Adult ICUs from 35 hospitals in Queensland, Australia, from 2006 to 2015.

PATIENTS:

A total of 218,462 patient admissions.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The outcome measure was inhospital mortality. The main study variable was decile of Index of Relative Socioeconomic Advantage and Disadvantage. The overall crude inhospital mortality was 7.8%; 9% in the most disadvantaged decile and 6.9% in the most advantaged decile (p < 0.001). Increasing socioeconomic disadvantage was associated with increasing severity of illness as measured by Acute Physiology and Chronic Health Evaluation III score, admission with a diagnosis of sepsis or trauma, cardiac, respiratory, renal, and hepatic comorbidities, and remote location. Increasing socioeconomic advantage was associated with elective surgical admission, hematological and oncology comorbidities, and admission to a private hospital (all p < 0.001). After excluding patients admitted after elective surgery, in the remaining 106,843 patients, the inhospital mortality was 13.6%, 13.3% in the most disadvantaged, and 14.1% in the most advantaged. There was no trend in mortality across deciles of socioeconomic status after excluding elective surgery patients. In the logistic regression model adjusting for severity of illness and diagnosis, there was no statistically significant difference in the odds ratio of inhospital mortality for the most disadvantaged decile compared with other deciles. This suggests variables used for risk adjustment may lie on the causal pathway between socioeconomic status and outcome in ICU patients.

CONCLUSIONS:

Socioeconomic status as defined as Index of Relative Socioeconomic Advantage and Disadvantage of the area in which a patient lives was associated with ICU admission diagnosis, comorbidities, severity of illness, and crude inhospital mortality in this study. Socioeconomic status was not associated with inhospital mortality after excluding elective surgical patients or when adjusted for severity of illness and admission diagnosis. Commonly used measures for risk adjustment in intensive care improve understanding of the pathway between socioeconomic status and outcomes.
Admission Features Associated With Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury: A Case-Control Study
Authors: Podell Jamie E. , Miller Serenity S. , Jaffa Matthew N. , Pajoumand Mehrnaz , Armahizer Michael , Chen Huanwen , Tripathi Hemantkumar , Schwartzbauer Gary T. , Chang Wan-Tsu W. , Parikh Gunjan Y. , Hu Peter , Badjatia Neeraj
Published: April 2021

OBJECTIVES:

Paroxysmal sympathetic hyperactivity occurs in a subset of critically ill traumatic brain injury patients and has been associated with worse outcomes after traumatic brain injury. The goal of this study was to identify admission risk factors for the development of paroxysmal sympathetic hyperactivity in traumatic brain injury patients.

DESIGN:

Retrospective case-control study of age- and Glasgow Coma Scale–matched traumatic brain injury patients.

SETTING:

Neurotrauma ICU at the R. Adams Cowley Shock Trauma Center of the University of Maryland Medical System, January 2016 to July 2018.

PATIENTS:

Critically ill adult traumatic brain injury patients who underwent inpatient monitoring for at least 14 days were included. Cases were identified based on treatment for paroxysmal sympathetic hyperactivity with institutional first-line therapies and were confirmed by retrospective tabulation of established paroxysmal sympathetic hyperactivity diagnostic and severity criteria. Cases were matched 1:1 by age and Glasgow Coma Scale to nonparoxysmal sympathetic hyperactivity traumatic brain injury controls, yielding 77 patients in each group.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Admission characteristics independently predictive of paroxysmal sympathetic hyperactivity included male sex, higher admission systolic blood pressure, and initial CT evidence of diffuse axonal injury, intraventricular hemorrhage/subarachnoid hemorrhage, complete cisternal effacement, and absence of contusion. Paroxysmal sympathetic hyperactivity cases demonstrated significantly worse neurologic outcomes upon hospital discharge despite being matched for injury severity at admission.

CONCLUSIONS:

Several anatomical, epidemiologic, and physiologic risk factors for clinically relevant paroxysmal sympathetic hyperactivity can be identified on ICU admission. These features help characterize paroxysmal sympathetic hyperactivity as a clinical-pathophysiologic phenotype associated with worse outcomes after traumatic brain injury.
Prone Positioning of Nonintubated Patients With Coronavirus Disease 2019—A Systematic Review and Meta-Analysis
Authors: Ponnapa Reddy Mallikarjuna , Subramaniam Ashwin , Afroz Afsana , Billah Baki , Lim Zheng Jie , Zubarev Alexandr , Blecher Gabriel , Tiruvoipati Ravindranath , Ramanathan Kollengode , Wong Suei Nee , Brodie Daniel , Fan Eddy , Shekar Kiran
Published: April 2021

OBJECTIVES:

Several studies have reported prone positioning of nonintubated patients with coronavirus diseases 2019–related hypoxemic respiratory failure. This systematic review and meta-analysis evaluated the impact of prone positioning on oxygenation and clinical outcomes.

DESIGN AND SETTING:

We searched PubMed, Embase, and the coronavirus diseases 2019 living systematic review from December 1, 2019, to November 9, 2020.

SUBJECTS AND INTERVENTION:

Studies reporting prone positioning in hypoxemic, nonintubated adult patients with coronavirus diseases 2019 were included.

MEASUREMENTS AND MAIN RESULTS:

Data on prone positioning location (ICU vs non-ICU), prone positioning dose (total minutes/d), frequency (sessions/d), respiratory supports during prone positioning, relative changes in oxygenation variables (peripheral oxygen saturation, Pao2, and ratio of Pao2 to the Fio2), respiratory rate pre and post prone positioning, intubation rate, and mortality were extracted. Twenty-five observational studies reporting prone positioning in 758 patients were included. There was substantial heterogeneity in prone positioning location, dose and frequency, and respiratory supports provided. Significant improvements were seen in ratio of Pao2 to the Fio2 (mean difference, 39; 95% CI, 25–54), Pao2 (mean difference, 20 mm Hg; 95% CI, 14–25), and peripheral oxygen saturation (mean difference, 4.74%; 95% CI, 3–6%). Respiratory rate decreased post prone positioning (mean difference, –3.2 breaths/min; 95% CI, –4.6 to –1.9). Intubation and mortality rates were 24% (95% CI, 17–32%) and 13% (95% CI, 6–19%), respectively. There was no difference in intubation rate in those receiving prone positioning within and outside ICU (32% [69/214] vs 33% [107/320]; p = 0.84). No major adverse events were recorded in small subset of studies that reported them.

CONCLUSIONS:

Despite the significant variability in frequency and duration of prone positioning and respiratory supports applied, prone positioning was associated with improvement in oxygenation variables without any reported serious adverse events. The results are limited by a lack of controls and adjustments for confounders. Whether this improvement in oxygenation results in meaningful patient-centered outcomes such as reduced intubation or mortality rates requires testing in well-designed randomized clinical trials.
The “Medical Education Roadshow:” Delivering Faculty Development to Busy Clinician Educators When They Least Expect It
Authors: Lau Trevin C. , Dzara Kristina , Khachadoorian-Elia Holly R. , Berkowitz Lori R.
Published: April 2021

Introduction:

Designing impactful faculty development for busy clinicians is challenging. Many may not recognize their impact on the learning environment or prioritize their development as educators. Our objective was to evaluate the feasibility and acceptability of a faculty development approach, the “Medical Education Roadshow,” which delivered succinct, actionable faculty development at regularly scheduled, departmental clinical business meetings.

Methods:

Between October 2018 and October 2019, we conducted six 15-minute “roadshows” for the Obstetrics and Gynecology faculty at one academic medical center. Each roadshow addressed a foundational education topic in an interactive manner with an emphasis on one take-away skill in teaching behavior. We utilized a simple, anonymous evaluation tool to obtain participant feedback and analyzed quantitative data descriptively and qualitative data thematically.

Results:

A total of 174 of 265 evaluations were returned (65.6% response rate). Participants indicated that the roadshows helped them think about teaching more effectively and offered one or more practical daily practice tips. Qualitative findings coalesced into two themes. First, participants identified multiple intended practice changes, including using more effective teaching strategies, being more deliberate about feedback, and modeling exemplary professional behavior. Second, participants recommended multiple improvement opportunities and future topics.

Discussion:

Busy clinical faculty were highly receptive to opportunities to improve as educators through the “roadshow” approach.
Nationwide Environmental Scan of Knowledge Brokers Training
Authors: Gaid Dina , Mate Kedar , Ahmed Sara , Thomas Aliki , Bussières André
Published: April 2021

Introduction:

Knowledge brokers (KBs) can promote the uptake of best practice guidelines in rehabilitation. Although many institutions offer training opportunities to health care professionals who wish to undertake KBs roles, the characteristics and content of those educational training opportunities (ETOs) are currently unknown. This study aimed to describe the ETOs available to rehabilitation professionals in Canada and determine whether the ETOs meet the competencies expected of the KBs roles.

Methods:

We conducted a Canada-wide environmental scan to identify ETOs using three strategies: online search, phone calls, and snowball. To be included in the study, ETOs had to be offered to rehabilitation professionals in Canada and be targeting KBs competencies and/or roles. We mapped each of the content to the KBs competencies (knowledge and skills) within the five roles of KBs: information manager, linking agent, capacity builder, facilitator, and evaluator.

Results:

A total of 51 ETOs offered in three Canadian provinces, British Columbia, Ontario, and Quebec, were included in the analysis. For KBs competencies, 76% of ETOs equipped attendees with research skills, 55% with knowledge brokering skills, and 53% with knowledge on implementation science. For KBs roles, over 60% of ETOs supported attendees to in performing the capacity builder role and 39% the evaluator role.

Discussion:

Findings suggest that ETOs focused primarily on preparing participants with the research and knowledge brokering skills required to perform the capacity builder and evaluator roles. Comprehensive educational training covering all KBs roles and competencies are needed.
Is Ultra Hypofractionated Radiation Therapy a Safe and Effective Treatment for Invasive Bladder Cancer in the Elderly?
Authors: Symon Noam , Mattout Jacoubo , Lewin Ron , Hammer Liat , Laufer Menachem , Berger Raanan , Leibowitz Raya , Dotan Zohar , Ben-Ayun Maoz , Tsvang Lev , Weiss Ilana , Symon Zvi
Published: April 2021

Purpose:

The aim was to determine the efficacy, safety, and tolerability of weekly ultra hypofractionated radiation therapy for older unfit patients with invasive bladder cancer.

Methods:

We retrospectively analyzed a cohort of patients with muscle invasive bladder cancer deemed unfit for chemoradiation therapy and thus treated with 6 weekly doses of 6 Gy using intensity modulated radiotherapy. Charlson comorbidity was calculated retrospectively. Cystoscopy and computed tomography were used to evaluate local control and toxicity using the common terminology criteria. Survival outcomes were estimated using the Kaplan-Meier method.

Results:

Twenty-two patients with a median age of 84 (range: 70 to 96) years were included. The median comorbidity index was 6±1.5 SD. Nineteen (90%) patients received the full 36 Gy dose. Median follow-up was 10±7 months (range: 6 to 27 mo). Local control in the bladder was achieved in 16 of 19 evaluable patients (84%). One-year overall survival was 62.5%, 1 patient had a retroperitoneal nodal recurrence and 3 patients developed distant metastasis. Grade 3 genitourinary and gastrointestinal toxicity was observed in 4 (18%) and 1 (4.5%) patients, respectively.

Conclusion:

Weekly ultra hypofractionated intensity modulated radiotherapy with image guidance and bladder training is an effective, safe, and well-tolerated regimen for older patients with invasive bladder cancer unfit for radical treatment.
Risk factors of chronic opioid use after surgical procedures in noncancer patients
Authors: Heo Kyu-Nam , Ah Young-Mi , Lee Ju-Yeun
Published: April 2021

BACKGROUND

Surgery is an indication for opioid prescription in noncancer patients, and chronic use of opioids is associated with overdose and abuse.

OBJECTIVES

We aimed to evaluate the prevalence and risk factors associated with chronic opioid use (COU) following surgery among noncancer patients.

DESIGN

A nationwide case–control study.

SETTING

Retrospective analysis of the annual national patient sample data from 2012 to 2018 in South Korea.

PATIENTS

Adults without cancer who had undergone surgery and received noninjectable opioids during hospital stay.

MAIN OUTCOME MEASURES

COU during 3 months following surgery.

RESULTS

A total of 15 543 participants were included, and the prevalence overall and in opioid-naïve users was 8.1 and 5.7%, respectively. Prior exposure patterns of opioids [intermittent user, adjusted odds ratio (aOR) 2.35; 95% CI, 2.00 to 2.77, and continuous user, aOR 8.58; 95% CI, 6.54 to 11.24] and concomitant use of benzodiazepine (in continuous user, aOR 18.60; 95% CI 11.70 to 29.55) were strongly associated with COU compared with naïve users. Morphine milligram equivalent, type of opioid strength at discharge and prescription of nonopioid analgesics at discharge were also associated with COU. Compared with minor surgery, knee (aOR 1.49; 95% CI 1.17 to 1.89), spine (aOR 1.65; 95% CI 1.33 to 2.06) and shoulder (aOR 2.54; 95% CI 1.97 to 3.27) procedures showed a significantly positive association with COU. Sensitivity analysis in opioid-naïve patients showed similar results.

CONCLUSION

About 8.1% of noncancer patients who had undergone surgery and were prescribed noninjectable opioids became chronic opioid users in Korea. Identified risk factors could be used to derive strategies for safe opioid use in noncancer patients in the future.
The role of icosapent ethyl in cardiovascular risk reduction
Authors: Goldenberg Ronald M. , Cheng Alice Y.Y. , Gilbert Jeremy D. , Lonn Eva M. , Pedersen Sue D. , Verma Subodh
Published: April 2021

Purpose of review

Elevated levels of triglycerides, independent of low-density lipoprotein cholesterol (LDL-C) levels and statin therapy, are associated with heightened cardiovascular risk.

Recent findings

Mixed omega-3 fatty acid formulations, which contain varying amounts of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), lower triglycerides levels but trial results with omega-3 fatty acids combinations have generally been neutral for cardiovascular outcomes. In contrast, the REDUCE-IT trial with icosapent ethyl (IPE), a highly purified ethyl ester of EPA, demonstrated reduced cardiovascular risk in individuals with established atherosclerotic cardiovascular disease or diabetes with at least one additional risk factor, despite having relatively well controlled LDL-C levels but triglycerides at least 135 mg/dl while on statin therapy. IPE offers an important new avenue for cardiovascular risk management in statin-treated individuals with elevated triglycerides.

This review summarizes the results from outcome trials conducted with omega-3 fatty acids, differentiating between those with combinations of EPA/DHA and those with pure EPA, as well as imaging and preclinical data that help explain the different cardiovascular efficacy observed. A list of frequently asked questions with evidence-based responses is provided to assist our colleagues and their patients in the shared-decision process when considering if IPE is appropriate for cardiovascular risk reduction.
Efficacy and Safety of Repeated Micropulse Transscleral Diode Cyclophotocoagulation in Advanced Glaucoma
Authors: Lim Edward J.Y. , Aquino Cecilia M. , Lun Katherine W.X. , Lim Dawn K.A. , Sng Chelvin , Loon Seng Chee , Chew Paul T.K. , Koh Victor T.C.
Published: April 2021

Precis:

Repeat micropulse transscleral cyclophotocoagulation (MPTCP) has some benefit in lowering intraocular pressure (IOP). There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi.

Aim:

This study aimed to determine the efficacy and safety of repeated MPTCP for an Asian population with refractory glaucoma.

Methods:

This is a retrospective case series of 43 eyes (43 patients) with severe glaucoma which underwent repeated MPTCP. Baseline parameters were taken from the visit just before the second MPTCP session. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, without further glaucoma reoperation, and ≤3 total MPTCP episodes. The IOP, number of IOP-lowering medications, and best-corrected visual acuity were documented preoperatively and postoperatively. Postoperative complications were also analyzed.

Results:

The mean age±SD was 57.4±18.2 years with a mean follow-up duration of 28.9±27.5 months. Neovascular glaucoma was the most common type of glaucoma [18 eyes (41.9%)]. The success rates at postoperative years 1, 2, and 3, and the latest follow-up were 36.4%, 42.9%, 32.0%, and 39.5%, respectively. The median survival time of repeat MPTCP was 4.6 months. Compared with the preoperative mean IOP (35.2±11.0 mm Hg), the mean IOP at postoperative years 1, 2, and 3, and latest follow-up, was 27.8±13.7 mm Hg (P=0.004), 27.4±12.4 (P=0.003), 31.8±13.2 (P=0.35), and 27.1±13.8 mm Hg (P=0.002), respectively. The mean number of IOP-lowering medications was reduced from 3.3±0.9 preoperatively to 2.8±1.3 at the final follow-up (P=0.007). Postoperative complications included prolonged hypotony [3 eyes (7.0%)] and phthisis bulbi [2 eyes (4.7%)].

Conclusion:

Repeated MPTCP is at best moderately effective in lowering IOP for eyes with advanced glaucoma.
Running a cardiology consult service during a pandemic: Experiences from the front lines
Authors: Valdez-Lowe Claudia , Parikh Sachin , Kenel Kristina L.
Published: April 2021

Millions of deaths worldwide have been attributed to the novel coronavirus (COVID-19). As case counts increased in the United States and resurgence occurred in Europe, health care systems across the country prepared for the influx of acutely ill patients. In response to this, our cardiology consult service was called to aid in the management of COVID-19 patients. We describe our experiences and the changes that were implemented.
CPAP-SAVER follow-up study to determine long-term adherence and associated factors
Authors: Shapiro April L. , Olson Joeli , Shafique Saima , Piamjariyakul Ubolrat
Published: April 2021

Background:

Many factors contribute to continuous positive airway pressure (CPAP) nonadherence, affecting health care burden. The original CPAP-SAVER study enrolled 66 CPAP-naive participants and showed high 1-month adherence and significantly higher apnea beliefs and CPAP attitude for the intervention group.

Purpose and methods:

Thirty-three participants from the original CPAP-SAVER study were recruited for a 3-year follow-up to determine adherence, examine the intervention effect, and identify adherence-associated factors.

Results:

Adherence rates dropped to 54.5% at 3 years, with a significant decrease in CPAP use hours (t = −2.37, p = .024) and nights (t = −4.05, p < .001). Group differences in beliefs and attitude were not sustained; however, beliefs (r = 0.57) and attitude (r = 0.44) were significant factors associated with adherence. Life satisfaction was significantly higher at present compared with before wearing CPAP (t = 5.17, p < .001).

Implications for practice:

The authors recommend intervention with a focus on apnea beliefs, CPAP attitude, and long-term support to promote CPAP adherence. Focus on CPAP attitude and beliefs and enhanced support early in the obstructive sleep apnea (OSA) treatment trajectory may promote long-term adherence and subsequently reduce the health care burden of OSA disease.
Interventional treatment of acute myocardial infarction-related cardiogenic shock
Authors: Josiassen Jakob , Møller Jacob E. , Holmvang Lene , Hassager Christian
Published: April 2021

Purpose of review

Acute revascularization is with some evidence the only intervention proven to improve the prognosis in myocardial infarction-related cardiogenic shock but several interventions are continuously being investigated in order to increase survival among these patients. In this review, several aspects related to the interventional treatment of cardiogenic shock are discussed chronologically from symptom debut to leaving the cardiac catheterization laboratory.

Recent findings

In the randomized CULPRIT-SHOCK trial, a culprit-only revascularization strategy was reported superior to immediate complete revascularization among patients with multivessel disease. Recent large-scale observational data underline the marked prognostic importance of time from medical contact to revascularization in acute myocardial infarction-related cardiogenic shock. Moreover, studies suggest a potential beneficial effect of a transradial vascular access as well as early initialization of mechanical circulatory support in carefully selected patients. This, however, needs further validation.

Acute revascularization remains a crucial part of the initial management of acute myocardial infarction-related cardiogenic shock. Among cardiogenic shock patients presenting with multivessel disease, a culprit-only approach should be the routine strategy. Time to revascularization plays a crucial role in the setting of cardiogenic shock, why prehospital optimization and triaging may be the most important factors in order to improve prognosis in AMI-related cardiogenic shock.
Mechanical ventilation in cardiogenic shock
Authors: Tavazzi Guido
Published: April 2021

Purpose of review

Mechanical ventilation is frequently needed in patients with cardiogenic shock. The aim of this review is to summarize and discuss the current evidence and the pathophysiological mechanism that a clinician should consider while setting the ventilator.

Recent findings

Little attention has been placed specifically to ventilatory strategies in patients with cardiogenic shock undertaking mechanical ventilation. Lung failure in patients with cardiogenic shock is associated with worsening outcome as well as a delay in mechanical ventilation institution. The hemodynamic profile and cardiogenic shock cause, considering the preload dependency of the failing heart, must be defined to adjust ventilatory setting.

Evidence is growing regarding the role of lung failure as adverse prognostic factor and beneficial effect of positive pressure ventilation as part of first-line treatment in patients with cardiogenic failure.
The evolving paradigm of precision medicine in lung cancer
Authors: Passiglia Francesco , Scagliotti Giorgio V.
Published: April 2021

Purpose of review

In this review, we report a complete and updated summary of the most recent treatment advances in the fields of oncogene-addicted disease and provide expert perspectives on the evolving paradigm of precision medicine in lung cancer patients.

Recent findings

The advent of innovative genome sequencing technologies is rapidly increasing the number of targetable molecular alterations in advanced nonsmall cell lung cancer (NSCLC), leading to the introduction of novel selective inhibitors into the clinical arena, showing unprecedent tumor responses against rare and elusive NSCLC targets. The results of the ADAURA trial suggested that targeting EGFR pathway in the adjuvant setting is a feasible and effective strategy. The routine use of next-generation sequencing (NGS) is currently recommended as new standard approach to profile advanced NSCLC samples while recent findings suggest the potential application of a plasma-based first approach for tumor genotyping. Innovative umbrella trials provide the right infrastructure to investigate the role of precision medicine in advanced NSCLC, but failed to show clinical benefit.

Implementing NGS-based molecular screening, increasing patients’ access to biomarker driven-clinical trials, ensuring equal access to molecular testing and innovative treatments, overcoming disparities and preserve health systems’ financial sustainability represents the main challenges of precision medicine worldwide.
Clinical Implications of Hematologic and Hemostatic Abnormalities in Children With COVID-19
Authors: Leeman Rachel , Shoag Jamie , Borchetta Michael , Mitchell Charles , Davis Joanna A. , Corrales-Medina Fernando F.
Published: April 2021

Leukopenia, thrombocytopenia, elevated D-dimer, and prolonged prothrombin time are considered poor prognostic factors in adults with acute Coronavirus Disease 2019. The prognostic significance of these abnormalities among pediatric patients remains underreported in the literature. This retrospective cohort study evaluates the prognostic implications of hematologic and hemostatic derangements in patients younger than 22-years-of-age who were admitted to a tertiary-care referral institution for management of acute Coronavirus Disease 2019 infection. Leukopenia and thrombocytopenia were identified as independent prognostic factors of disease severity. Although the majority of children, with available results, had elevated D-dimer or prolonged prothrombin time upon initial presentation, these markers were not found to be associated with the development of severe clinical complications.
Whole-exome Sequencing of Epstein-Barr Virus–associated Pulmonary Carcinoma With Low Lymphocytic Infiltration Shows Molecular Features Similar to Those of Classic Pulmonary Lymphoepithelioma-like Carcinoma
Authors: Yeh Yi-Chen , Ho Hsiang-Ling , Lin Chia-I , Chou Teh-Ying , Wang Yu-Chao
Published: April 2021

Pulmonary lymphoepithelioma-like carcinoma (LELC) is a distinct type of Epstein-Barr virus (EBV)-associated non–small cell carcinoma characterized by a syncytial growth pattern with heavy lymphocytic infiltration. We recently identified a group of non–small cell carcinomas, which are also associated with EBV but lack significant lymphocytic infiltration. These EBV-associated pulmonary carcinomas with low lymphocytic infiltration morphologically resemble nonkeratinizing squamous cell carcinoma, but their patient characteristics are more similar to those of LELC, including female sex and nonsmoking status. To clarify the relationships between these disease entities, in this study, we explored the molecular characteristics of the EBV-associated carcinomas with low lymphocytic infiltration using whole-exome sequencing and compared their molecular profiles with those of classic LELC and pulmonary squamous cell carcinoma. We demonstrate that the molecular characteristics of EBV-associated carcinomas with low lymphocytic infiltration are highly similar to those of classic LELC. Both show low tumor mutational burden, lack of commonly mutated driver genes in other types of non–small cell lung cancer, similar mutational signature involving APOBEC-related mutations, and enrichment of CD274 (programmed death-ligand 1) amplification. These molecular characteristics are very different from those of pulmonary squamous cell carcinoma. The unique patient demographics and molecular characteristics shared by EBV-associated carcinomas with low lymphocytic infiltration and classic LELC suggest that these tumors represent one single disease entity defined by EBV association. This study supports the proposal for the usage of the term “EBV-associated pulmonary carcinoma” to encompass the entire morphologic spectrum of this distinct EBV-associated disease entity.
Sigmoid Diverticulitis in an Obese Pediatric Patient Without Genetic Predisposition
Authors: Bartel Megan , Burnett Christopher , Barnes Danielle
Published: April 2021

Sigmoid diverticulitis has historically been a rare cause of abdominal pain in pediatrics, with minimal cases documented in the literature. The patient studied is one of the first reported cases of acquired pediatric uncomplicated sigmoid diverticulitis in whom lifestyle was the main contributing factor, as all associated known genetic risk factors were absent. Given the rarity of the diagnosis, many pediatricians may not consider the diagnosis; however, with the increasing incidence in younger patients, consideration of diverticulitis on the differential diagnosis with lower abdominal pain, especially in patients predisposed to diverticular disease, is increasingly important to avoid misdiagnosis and potential delays in appropriate treatment.
Brief Report: COVID-19 Testing, Characteristics, and Outcomes Among People Living With HIV in an Integrated Health System
Authors: Chang Jennifer J. , Bruxvoort Katia , Chen Lie H. , Akhavan Bobak , Rodriguez Janelle , Hechter Rulin C.
Published: April 2021

Background:

Understanding the attributes of COVID-19 clinical severity among people living with HIV (PLWH) compared with those in HIV-uninfected patients is critical for risk stratification and treatment strategies.

Methods:

We conducted a retrospective study at Kaiser Permanente Southern California among PLWH aged 18 years or older. We compared the incidence of SARS-CoV-2 molecular testing, COVID-19 diagnosis, and COVID-19 hospitalization among PLWH and HIV-uninfected adults. A chart review was conducted for PLWH with COVID-19 to examine viral suppression of HIV and most recent CD4+ counts in the year before COVID-19 diagnosis, known exposures to COVID-19, and clinical presentation.

Results:

Between March 1, 2020, and May 31, 2020, the incidence of SARS-CoV-2 molecular testing, COVID-19 diagnosis, and COVID-19 hospitalization was 551.2, 57.0, and 9.3 per 10,000 PLWH, respectively, compared with 268.4, 34.6, and 5.3 per 10,000 HIV-uninfected individuals, respectively. Among those with COVID-19, the distribution of race/ethnicity, smoking status, and comorbidities was similar in PLWH and HIV-uninfected patients; however, PLWH were mostly men, younger, and less obese than HIV-uninfected individuals. Health care utilization regarding emergency care and hospitalizations in the year before COVID-19-related hospitalization was similar between the groups. Overall, HIV was virologically suppressed in >95% of PLWH with COVID-19, and HIV viral load and CD4+ status did not differ between hospitalized and nonhospitalized patients.

Conclusions:

In this population of patients with well-controlled HIV infection, the incidence of testing, diagnosis, and hospitalization for COVID-19 was higher in PLWH than that in HIV-uninfected patients.
Barriers, benefits and interventions for improving the delivery of telemental health services during the coronavirus disease 2019 pandemic: a systematic review
Authors: Siegel Ashley , Zuo Yushen , Moghaddamcharkari Nika , McIntyre Roger S. , Rosenblat Joshua D.
Published: April 2021

Purpose of review

To reduce the spread of infection from the coronavirus disease 2019 (COVID-19), mental healthcare facilities were forced to make the rapid transition from face-to-face services to virtual care. This systematic review aims to synthesize the extant literature reporting on barriers of telemental health (TMH) during the COVID-19 pandemic and how facilities have worked to overcome these barriers, to inform best practices for TMH delivery.

Recent findings

Most recent findings came from case studies from mental health professionals which reported on barriers related to institutional, provider and patient factors, and how these barriers were overcome. Common barriers identified in the literature include: technological difficulties; issues regarding safety, privacy and confidentiality; therapeutic delivery and the patient-provider relationship; and a loss of sense of community. Studies also reported on the benefits to TMH interventions/tools, as well as suggestions for improvements in the delivery of TMH services.

As the COVID-19 pandemic evolves, mental healthcare providers continue to find creative and feasible solutions to overcome barriers to the delivery of TMH. Dissemination of these solutions is imperative to ensure the best quality of mental healthcare for patients across the globe.
Gulf War veterans exhibit broadband sleep EEG power reductions in regions overlying the frontal lobe
Authors: Moffet Eric W. , Jones Stephanie G. , Snyder Theodore , Riedner Brady , Juergens Timothy
Published: April 2021

Aims

Nearly a third of U.S. veterans who deployed in support of the 1990-1991 Persian Gulf War are affected by Gulf War illness (GWI). Here we aimed to characterize whether subjective sleep complaints in GWI veterans are associated with objective sleep EEG disturbances relative to healthy veterans and controls; and whether Gulf War veterans show alterations in neural activity during sleep that differentiate them from healthy subjects.

Main methods

We used high-density EEG (HDEEG) to assess regional patterns of rapid eye movement (REM) sleep and non-REM (NREM) sleep between three groups: Gulf War male veterans with fatigue and GWI, Gulf War male veterans without fatigue or GWI, and control males. The groups were matched relative to age, sex and obstructive sleep apnea. Topographic comparisons of nocturnal NREM and REM sleep were made between groups for all frequency bands.

Key findings

Topographic analysis revealed a broadband reduction in EEG power in a circumscribed region overlying the frontal lobe in both groups of Gulf War veterans, regardless of GWI and fatigue. This frontal reduction in neural activity was present, to some extent, across all frequency bands in NREM and REM sleep.

Significance

Given that our findings were observed in all Gulf War veterans, it appears unlikely that frontal sleep HDEEG power reductions prove wholly responsible for fatigue symptoms. These results provide avenues for research and underpin the importance of maintaining a high index of suspicion when providing clinical care to formerly deployed veterans of the Persian Gulf War.
Global cognition is related to upper-extremity motor skill retention in individuals with mild-to-moderate Parkinson disease
Authors: VanGilder Jennapher Lingo , Lopez-Lennon Cielita , Paul Serene S. , Dibble Leland E. , Duff Kevin , Schaefer Sydney Y.
Published: April 2021

Background and Purpose

Cognitive impairment has been linked to poor motor learning and rehabilitation outcomes in older adult and stroke populations, but this remains unexplored in individuals with Parkinson disease (PD). The purpose of this secondary data analysis from a recent clinical trial (NCT02600858) was to determine if global cognition was related to nine-day skill retention after upper-extremity motor training in individuals with PD.

Methods

Twenty-three participants with idiopathic PD completed three consecutive days of training on an upper-extremity task. For the purposes of the original clinical trial, participants trained either “on” or “off” their dopamine replacement medication. Baseline, training, and shorter-term (48-hour) retention data have been previously published. Global cognition was evaluated using the Montreal Cognitive Assessment (MoCA). Participant age, baseline performance, MoCA score, and group (medication “on”/”off”) were included in a multivariate linear regression model to predict longer-term (nine day) follow-up performance. Baseline and follow-up performance were assessed for all participants while “on” their medication.

Results

MoCA score was positively related to follow-up performance, such that individuals with better cognition performed better than those with poorer cognition. Participant age, baseline performance, and medication status were unrelated to follow-up performance.

Discussion and Conclusions

Results of this secondary analysis align with previous work that suggest cognitive impairment may interfere with motor learning in PD, and that assessing cognition could provide prognostic information about an individual’s responsiveness to motor rehabilitation for a number of clinical populations.
SARS-CoV-2 Vaccination Uptake in a Correctional Setting
Authors: Berk Justin , Murphy Matthew , Chan Philip A. , Kane Kimberly , Rich Jody , Brinkley-Rubinstein Lauren
Published: April 2021

Between December 2020 and February 2021, the Rhode Island Department of Corrections offered SARS-CoV-2 vaccination to all correctional staff and sentenced individuals incarcerated in the state. During this initial campaign, 76.4% (1106 / 1447) of sentenced individuals and 68.4% (1008 / 1474) of correctional staff accepted and received the vaccine. This study demonstrates the feasibility and efficiency of vaccine implementation in a carceral setting.
Genetic Susceptibility Of Cytotoxic T Lymphocyte-Associated Antigen 4 Gene Polymorphism In The Onset Of Arthritis
Authors: Mukhtar Maryam , Sheikh Nadeem , Suqaina Saira Kainat , Saleem Tayyaba , Mehmood Rabia , Khawar Muhammad Babar
Published: April 2021

Cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) gene plays a vital role in the activation of T-cells as a down regulator. CTLA-4 gene polymorphisms have implicated a potential risk factor for autoimmune disorders like arthritis. Therefore the current study was designed to determine the association of CTLA-4 gene polymorphism in the onset of rheumatoid and osteoarthritis in Pakistani individuals. Genotyping was performed on 300 RA, 316 OA, and 412 control subjects by direct sequencing method as well as polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. It was observed that allelic and genotypic frequency of rs5742909, rs231775, rs4553808, rs733618, and rs3087243 were significantly varied among patients and controls and considered as a significant risk factor in the onset of RA as well as OA. However, no mutation was identified on the rs11571317 polymorphic site. Haplotype CAGTCA and CAG TCG act as a protectant against disease onset whereas CAACCG was significant in disease onset. Mutation on rs231775 polymorphic site lead to the change of threonine into alanine It was concluded that CTLA-4 gene polymorphism is a significant risk factor in the onset of RA as well as OA. Large scale survey is required for the screening of the genetic markers for pre-diagnosis of the disease.

SUMMARY STATEMENT

The study summarized that CTLA-4 gene polymorphism plays a key role in the arthritis onset in Pakistani population.
A triangulated study on non-pharmacological management of Alzheimer’s disease in Mauritius
Authors: Dorkhy Geeta Devi , Smita Goorah , Ameenah Sorefan
Published: April 2021

Dementia is a neurodegenerative disease, with more than 50 million people worldwide. Nearly 60% are living in the low and middle-income countries [1]. Mauritius has a rising population of elderly people, of 7.5% above 65 years [2]. Currently 14,000 people with Alzheimer’s disease (AD), show very modest improvements with pharmacological therapies. Alzheimer’s Association in Mauritius, the only NGO, which assist person with AD and offer multiple non-pharmacological therapies (NPT).

Objectives

The main study aim is to find the outcomes of NPT in the management of AD and the correlation of data in mixed studies.

Setting

The participants were recruited from Alzheimer’s Association Mauritius, the only NGO. The center provides NPT such as cognitive training, reminiscence therapy, socialization and group interactive games.

Primary and secondary outcome measures

Both quantitative and qualitative studies were triangulated to find similarities (matched) and unsimilar (unmatched) results.

Result

Quantitative data (n=42) analysis showed a direct statistical decline in higher function (IADL) with respect to decreasing cognition. Qualitative study (n=20) emerged with 7 main themes among which ‘dependency in AD’ was a main theme. Mixed study results showed 6 out of 7 main themes were linked to/ matching to statistical results after triangulation.

Conclusion

NPT is an effective tool in the management of AD in Mauritius. Triangulated studies allowed in depth analysis of the patient.

Strengths and limitations of the study

Mixed study provides in depth analysis

Data speaks for itself, it is lived experience

Mixed studies complement each other

However, it is a time consuming process

Participant unwillingness to participate
Clinical manifestations of hospitalized COVID-19 patients in Bangladesh: a 14-day observational study
Authors: Shaha Modhusudon , Islam Md. Azizul , Huq Faizul , Roy Bithi , Kabir Ashraful , Salimullah Md. , Mamun-Al-Mahtab  , Fazle Akbar Sheikh Mohammad
Published: April 2021

Objectives

Severe acute respiratory coronavirus-2 (SARS-CoV-2) is currently a significant public health concern and causing a pandemic in the world. Despite of immense attention to the coronavirus disease-2019 (COVID-19), very little attention has been given to the kinetics of disease progression in infected patients. Therefore, in this study, we present a 14-day clinical observation of hospital-admitted COVID-19 patients.

Methods

After recording the demography of 42 COVID-19 patients on day 1, we observed the clinical progression for 14 days by investigating the hematological and biochemical responses of patients blood and serum, respectively.

Results

Approximately 62% of the hospital-admitted COVID-19 patients presented cough, followed by fever (approximately 52%). The top comorbidities of these patients were hypertension (30%) and diabetes mellitus (19%). The average blood hemoglobin level was slightly low among the patients in early days of infection and went up to the normal level on the latter days. A substantial increase in the level of ALT/SGPT (up to 106 units/L; SEM: 12.64) and AST/SGOT (up to 64.35 units/L; SEM: 5.013) in COVID-19 patients was observed, which may suggest that infection with CoV-2019 is associated with the functionality of other organs of COVID-19 patients.

Conclusion

This 14-day observational study may help clinicians to decide the choice of treatment of COVID-19 patients.
Quantitative Gradient Echo MRI Identifies Dark Matter as a New Imaging Biomarker of Neurodegeneration that Precedes Tissue Atrophy in Early Alzheimer Disease
Authors: Kothapalli Satya V.V.N. , Benzinger Tammie L. , Aschenbrenner Andrew. J. , Perrin Richard. J. , Hildebolt Charles. F. , Goyal Manu. S. , Fagan Anne. M. , Raichle Marcus. E. , Morris John. C. , Yablonskiy Dmitriy. A.
Published: April 2021

Background

Currently, brain tissue atrophy serves as in vivo MRI biomarker of neurodegeneration in Alzheimer Disease (AD). However, postmortem histopathological studies show that neuronal loss in AD exceeds volumetric loss of tissue and that loss of memory in AD begins when neurons and synapses are lost. Therefore, in vivo detection of neuronal loss prior to detectable atrophy in MRI is essential for early AD diagnosis.

Objective

To apply a recently developed quantitative Gradient Recalled Echo (qGRE) MRI technique for in vivo evaluation of neuronal loss in human hippocampus.

Methods

Seventy participants were recruited from the Knight Alzheimer Disease Research Center, representing three groups: Healthy controls [Clinical Dementia Rating® (CDR®)=0, amyloid β (Aβ)-negative), n=34]; Preclinical AD (CDR=0, Aβ-positive, n=19); and mild AD (CDR=0.5 or 1, Aβ-positive, n=17).

Results

In hippocampal tissue, qGRE identified two types of regions: one, practically devoid of neurons, we designate as “Dark Matter”, the other, with relatively preserved neurons - “Viable Tissue”. Data showed a greater loss of neurons than defined by atrophy in the mild AD group compared with the healthy control group - neuronal loss ranged between 31% and 43% while volume loss ranged only between 10% and 19%. The concept of Dark Matter was confirmed with histopathological study of one participant who underwent in vivo qGRE 14 months prior to expiration.

Conclusion

in vivo qGRE method identifies neuronal loss that is associated with impaired AD-related cognition but is not recognized by MRI measurements of tissue atrophy, therefore providing new biomarkers for early AD detection.
Sentinel seroprevalence of SARS-CoV-2 in the Gauteng province, South Africa August to October 2020
Authors: George Jaya A , Khoza Siyabonga , Mayne Elizabeth , Dlamini Sipho , Kone Ngalula , Jassat Waasila , Chetty Kamy , Centner Chad , Pillay Taryn , Maphayi Mpho R , Mabuza Dineo V , Maposa Innocent , Cassim Naseem
Published: April 2021

Background

Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) are for tracking the Covid-19 epidemic and are lacking for most African countries.

Objectives

To determine the prevalence of antibodies against SARS-CoV2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa

Methods

This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Services laboratories situated in the City of Johannesburg (COJ) district, South Africa. Collection was from 1 August until the 31 October 2020. We extracted accompanying laboratory results for haemoglobin A1c, creatinine, HIV, viral load, and CD4+ T cell count. An anti-SARS -CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population weighted and test adjusted seroprevalence. Multivariate logistic regression method was used to determine if age, sex, HIV and diabetic status were associated with increased risk for seropositivity.

Results

A total of 6477 samples were analysed; the majority (5290) from the COJ region. After excluding samples with no age or sex stated, the model population weighted and test adjusted seroprevalence for COJ (N=4393) was 27.0 % (95% CI: 25.4-28.6%). Seroprevalence was highest in those aged 45-49 [29.8% (95% CI: 25.5-35.0 %)] and in those from the most densely populated areas of COJ. Risk for seropositivity was highest in those aged 18-49 as well as samples from diabetics (aOR =1.52; 95% CI: 1.13-2.13; p=0.0005) and (aOR=1.36; 95% CI: 1.13-1.63; p=0.001) respectively.

Conclusion

Our study conducted during the first wave of the pandemic shows high levels of infection among patients attending public health facilities in Gauteng.