bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic performance of GenBody COVID-19 rapid antigen test for laboratory and non-laboratory medical professionals in real practice: A retrospective study
Authors: Lin Pei-Chin , Huang Chun-Jung , Lu Yen-Ming , Huang Huei-Ling , Wu Zong-Ying , Chang Chih-Chun , Chu Fang-Yeh
Published: August 2023

Point-of-care tests for coronavirus disease 2019 (COVID-19) antigen detection have been widely used for rapid diagnosis in various settings. However, research on the diagnostic performance of the COVID-19 antigen test performed by non-laboratory personnel is limited. In this study, we aimed to elucidate the diagnostic performance of GenBody COVID-19 rapid antigen between laboratory professionals and non-laboratory staff. We retrospectively analyzed the data of patients who underwent both GenBody COVID-19 rapid antigen testing and reverse transcription polymerase chain reaction (RT-PCR) between November 01, 2021, and June 30, 2022. The diagnostic performance of the antigen test was compared between laboratory and non-laboratory operators, using RT-PCR as the gold standard. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, positive predictive value, negative predictive value, and accuracy were calculated and sensitivity analysis was performed based on the PCR cycle threshold (Ct) value. Of the 11,963 patients, 1273 (10.6%) tested positive using real-time RT-PCR. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, positive predictive value, negative predictive value, and accuracy of the GenBody COVID-19 rapid antigen test with 95% confidence interval were 79.92% (77.26%–82.39%), 99.23% (98.73%–99.57%), 103.25 (62.31–171.11), 0.2 (0.18–0.23), 510.18 (299.81–868.18), 98.11% (96.91%–98.85%), 90.75% (89.64%–91.75%) and 92.76% (91.76%–93.67%), respectively, for non–laboratory staff and 79.80% (74.78%–84.22%), 99.99% (99.94%–100.00%), 6983.92 (983.03–49617.00), 0.2 (0.16–0.25), 34566.45 (4770.30–250474.46) 99.58% (97.09%–99.94%), 99.32% (99.15%–99.46%), and 99.33% (99.13%–99.48%), respectively, for laboratory staff. Notably, when the PCR Ct value exceeded 25, the sensitivity of both the groups decreased to < 40%. The diagnostic performance of GenBody COVID-19 rapid antigen performed by non-laboratory staff was comparable to that of laboratory professionals. However, it should be noted that the sensitivity of the antigen tests decreased when the PCR Ct value exceeded 25. Overall, the GenBody COVID-19 antigen test is a viable option for non-laboratory staff during an epidemic.
Incorporating a Patient Safety and Quality Course Into the Nursing Curriculum: An Assessment of Student Gains
Authors: Ahmed Fasih Ali , Choudhary Roha Ahmad , Khan Hamza , Ayub Farwa , Hassan Syed Sabih ul , Munir Tahir , Asif Fozia , Ajani Khairulnissa , Jaffer Mehtab , Tharani Zahra , Aboumatar Hanan J. , Haider Adil , Latif Asad
Published: August 2023

Background

Training nursing students on quality and patient safety (PS) is crucial to ensuring safe healthcare practices given the key role nurses play on the healthcare team. The aim of this study was to evaluate the impact of quality and PS course on the knowledge, and system thinking of students at different stages of the undergraduate nursing course.

Methods

A 4.5-day quality improvement and PS course was conducted at the Aga Khan University School of Nursing and Midwifery for 146 second- and 139 fourth-year students. Students’ knowledge, self-assessment of knowledge and skills, and system thinking were assessed using pretest and posttest.

Results

Of the total of 20 points, the course significantly improved students’ knowledge by a mean of 4.91 points for second-year students (95% confidence interval [CI], 4.32–5.51) and 3.46 points for fourth-year students (95% CI, 2.90–4.02) between pretest and posttest. For systems thinking, the Systems Thinking Scale scores increased by 0.41 points (95% CI, 0.29–0.52) for second-year students and 0.33 points (95% CI, 0.22–0.44) for fourth-year students out of the total of 5 points. The self-assessment scores significantly increased on postcourse assessment for second (P < 0.05) and fourth-year students (P < 0.001). Positive experience reported by students in the narrative reflections complemented these results.

Conclusions

There was a significant increase in nursing students’ knowledge, self-efficacy, and system thinking after participating in this short PS course. Replication at a national level may improve safety knowledge and skills among nursing students with subsequent gains in the safety of healthcare delivery in Pakistan.
The Effect of Xenograft and Platelet-Rich Plasma in the Surgical Management of Intrabony Defects in Periodontitis Patients: A Systematic Review
Authors: Mehta Vini , Fiorillo Luca , Langaliya Akshayraj , Obulareddy Vishnu Teja , Cicciu Marco
Published: August 2023

When treating intrabony defects to regenerate periodontal structure, platelet-rich plasma (PRP) alone or in conjunction with various grafting materials, enamel matrix proteins, and barrier membranes have shown promising results. This evidence-based review aimed to systematically appraise the efficacy of xenograft in combination with PRP in the surgical treatment of periodontal intrabony defects in comparison to xenograft alone in terms of clinical and radiographic outcomes in adults with periodontitis. Electronic and manual data were searched exhaustively by 2 reviewers, including PubMed-Medline, Cochrane Central Register of Controlled Trials, Embase and Scopus from the earliest available date till January 31, 2023 without restriction on language. Randomized controlled clinical trials of either parallel or a split-mouth design and studies where xenograft and PRP were in the intervention group or as a comparator was included. After screening the articles, 3 studies were included. The current systematic review reveals that PRP used as an adjunct with a xenograft resulted in a significant reduction in pocket depth and greater clinical attachment level gain in comparison to xenograft alone. The analysis of the present review concludes that PRP in conjunction with xenograft for the treatment of intrabony defects shows promising outcomes. However, owing to the short follow-up time and heterogeneity of included studies, caution should be followed while using this material clinically.
Using the Dermal Fat Graft as a Barrier Membrane in Unilateral Alveolar Cleft Grafting: A Randomized Clinical Trial
Authors: El Kassaby Marwa , Abd El Fatah Karim Tarek , Yehia Mahmoud , Gaber Ramy Mohamed , Asar Aseel , El Hadidi Yasser Nabil
Published: August 2023

Introduction:

Alveolar cleft grafting is a surgical procedure that usually suffers from inferior results.

Methodology:

The patients were divided into 2 groups; study and control. In the study group, the grafted site was covered with a dermal fat graft.

Results:

Showed that the bone fill percentage (Bergland Scale) recorded in the study was significantly better (P=0.03); the study group had 14 successful cases out of 18 compared with the control, which had only 9 out of 20. The study group significantly (P= 0.002) better bone fill (71%±32%) compared with the control (46%±33%). There was a significant reduction in dehiscence in the study compared with the control (P=0.02); the study group had no dehiscence compared with the control, which had 5 dehiscence.

Conclusion:

The dermal fat graft use as a barrier membrane was successful in improving alveolar cleft grafting.
History of Cranial Surgery in World War I: Experience on the Italian Front
Authors: Nataloni Angelo , Carbonaro Riccardo , Amendola Francesco , Vaienti Luca , Barbanera Andrea , Cottone Giuseppe , Bonetti Mario A. , Zingaretti Nicola , Zanotti Bruno
Published: August 2023

Since ancient history, men have been attempting to intervene when skull trauma occurs. The majority of traumas were always linked to war injuries, and in the modern era, the culprit was reached during World War I. Cranial traumas in wartime were very common, and consequently, physicians in wartime became particularly interested in the subject of cranial traumatology. In the following text, we want to bring to light the experience of some of the pioneers of cranial surgery in Italy during the First Great War. In fact before the war, very few medical officers had received training in central nervous system surgery. In addition, the surgical instruments for that clinical activity were inadequate and obsolete, but to deal with the medical emergency that had arisen on the front lines, the Italian government established Battlefield Medical Schools. And it is also from the reports and lectures of surgeons working on the front lines that the next generations of neurosurgeons were able to develop this surgical field into the complex and well-established surgical specialty that it is today.
Precision Surgery for Orbital Cavernous Hemangiomas: The Role of Three-Dimensional Printing in Individualized Resection—An Educational Experience
Authors: Westarp Emilia , Thieringer Florian M. , Roethlisberger Michel
Published: August 2023

Orbital cavernous hemangiomas are the most common primary orbital tumors in adults, providing challenges for optimal surgical approach planning within an anatomically complex area with close proximity to vital neurovascular structures. The authors present an individualized lateral mini-orbitozygomatic approach for the resection of an orbital cavernous haemangioma based on a preoperative 3-dimensional–printed model. This individualized approach enabled the surgeons to achieve optimal exposure while maintaining safety during the resection of the lesion, but also to respect the patient’s physiognomy and hairline. In addition, the model was used for patient informed consent, helping the patient understand the procedure. Although adding additional effort to preoperative planning, 3-dimensional model-based approaches can offer great benefits when it comes to customizing surgical approaches, especially for anatomically challenging resections.
Multiple Facial Basal Cell Carcinoma With Xeroderma Pigmentosum
Authors: Wang Xi’ao , Xie Kai , Guo Xuan , Bi Zhaohua
Published: August 2023

Multiple basal cell carcinomas are rare in children and adolescents. Xeroderma pigmentosum (XP) is a rare autosomal recessive hereditary disease characterized by photosensitivity, changes in skin pigmentation, and early onset of skin cancer. XP is extremely rare in clinical practice, with only a few cases worldwide. XP is clinically incurable. The main goal of treating this disease is to diagnose as early as possible, educate patients to strictly avoid ultraviolet radiation for life, and follow up regularly to treat skin malignant tumors in time. The authors report a 15-year-old boy with facial multiple basal cell carcinoma with XP. Its medical history, clinical features, auxiliary examination, and surgical treatment process have great reference value for the in-depth understanding of the disease. The authors will discuss how to delay the progression of the disease and treat the existing lesions in different clinical stages of the disease in combination with the existing relevant literature.
Median Cleft Lip
Authors: Menderes Adnan , Ateşşahin Fatih Berk , Babahan Tahir , Terzi Merve , Atalmiş Safa Eren , Çağli Hasan Basri
Published: August 2023

Complete or partial lip clefts in the midline of the upper lip are defined as median clefts of the upper lip. In 1974, Tessier numbered the craniofacial clefts from 0 to 14 counterclockwise in a study involving 336 patients. Upper lip midline clefts are named Tessier 0 clefts. Despite the diversity in classifications, upper lip midline cleft is rare. Its incidence among cleft patients varies between 0.43% and 0.73%. If the more common forms of cleft lip and palate are not taken into account, the incidence of atypical cleft is estimated at 1/105. A median upper lip cleft can be defined as a cleft that passes vertically through the midline of the upper lip. These clefts occur due to incomplete or complete nondevelopment of the medial nasal prominences. In this study, the authors shared a case diagnosed prenatally and referred to their clinic for cleft lip repair.
Comparison of phenobarbital monotherapy to a benzodiazepine-based regimen for management of alcohol withdrawal syndrome in trauma patients
Authors: Fleenor Lori Montana , Beavers Jennifer R. , Tidwell William P. , Atchison Leanne , Woo Edward , Medvecz Andrew J. , Beyene Robel T. , Kast Kristopher , Marcovitz David , Dennis Bradley M. , Guillamondegui Oscar D. , Smith Michael C.
Published: August 2023

BACKGROUND

Alcohol withdrawal syndrome (AWS) is associated with increased morbidity and mortality in the trauma population. Benzodiazepines (BZDs) are standard of care for AWS; however, given the risk of delirium with BZDs and reports of BZD-refractory withdrawal, phenobarbital (PHB) has emerged as an alternative therapy for AWS. Safety and efficacy studies of PHB for AWS in trauma patients are lacking. Our aim was to compare a BZD versus PHB protocol in the management of AWS in trauma patients.

METHODS

We performed a retrospective cohort study at a level 1 trauma center of patients at risk for AWS managed with either a BZD or a low-dose oral PHB regimen. Patients were excluded if they were taking BZDs or barbiturates before admission, received propofol or dexmedetomidine before initiation of the study drug, presented with delirium tremens or seizures, or died or discharged within 24 hours of presentation. The primary outcome was complicated AWS (seizures or alcohol withdrawal delirium/delirium tremens). Secondary outcomes included uncomplicated AWS; therapy escalation; oversedation; delirium-, intensive care unit–, and ventilator-free days; and length of stay.

RESULTS

A total of 411 patients were identified; 118 received BZD, and 293 received PHB. The odds of developing complicated AWS with PHB versus BZD-based therapy were not statistically significant (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.21–1.39); however, patients receiving PHB were less likely to develop uncomplicated AWS (OR, 0.08; 95% CI, 0.04–0.14) and less likely to require escalation of therapy (OR, 0.45; 95% CI, 0.24–0.84). The PHB group had a length of stay 3.1 days shorter than the BZD group (p = 0.002). There was no difference in intensive care unit–, ventilator-, or delirium-free days.

CONCLUSION

A PHB-based protocol for the management of AWS is a safe and effective alternative to BZD-based regimens in trauma patients.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
PersistentIDHmutations are not associated with increased relapse or death in patients withIDH-mutated acute myeloid leukemia undergoing allogeneic hematopoietic cell transplant with post-transplant cyclophosphamide
Authors: Ravindra Niveditha , Dillon Laura W. , Gui Gege , Smith Matthew , Gondek Lukasz P. , Jones Richard J. , Corner Adam , Hourigan Christopher S. , Ambinder Alexander J.
Published: August 2023

The presence of measurable residual disease (MRD) prior to an allogeneic hematopoietic transplant (alloHCT) in Acute Myeloid Leukemia (AML) has been shown to be associated with an increased risk of post-transplant relapse. Since the Isocitrate Dehydrogenase genes (IDH1/2) are mutated in a considerable proportion of patients with AML, we studied if these mutations would serve as useful targets for MRD. Fifty-fiveIDH-mutated AML patients undergoing non-myeloablative alloHCT with post-transplant cyclophosphamide at a single center were sequenced at baseline using a multi-gene panel followed by targeted testing for persistentIDHmutations at the pre- and post-alloHCT timepoints by digital droplet PCR or error-corrected next generation sequencing. The cohort included patients who had been treated withIDHinhibitors pre- and post-transplant (20% and 17% forIDH1and 38% and 28% forIDH2). Overall, 55% of patients analyzed had detectableIDHmutations during complete remission prior to alloHCT. However, there were no statistically significant differences in overall survival (OS), relapse-free survival (RFS), and cumulative incidence of relapse (CIR) at 3 years between patients who tested positive or negative for a persistentIDHmutation during remission (OS:IDH1p=1,IDH2p=0.87; RFS:IDH1p=0.71,IDH2p= 0.78; CIR:IDH1p=0.92,IDH2p=0.97). There was also no difference in the prevalence of persistentIDHmutation between patients who did and did not receive anIDHinhibitor (p=0.59). Mutational profiling of available relapse samples showed that 8 out of 9 patients still exhibited the originalIDHmutation, indicating that theIDHmutations remained stable through the course of the disease. This study demonstrates that persistentIDHmutations during remission is not associated with inferior clinical outcomes after alloHCT in patients with AML.
Clinical outcomes after viraemia among people receiving dolutegravir versus efavirenz-based first-line antiretroviral therapy in South Africa
Authors: Asare Kwabena , Lewis Lara , van der Molen Johan , Sookrajh Yukteshwar , Khubone Thokozani , Moodley Pravikrishnen , Lessells Richard J , Naidoo Kogieleum , Sosibo Phelelani , Garrett Nigel , Dorward Jienchi
Published: August 2023

Introduction

We aimed to compare clinical outcomes after viraemia between dolutegravir versus efavirenz-based first-line antiretroviral therapy (ART) as evidence is lacking outside clinical trials in resource-limited settings.

Methods

We conducted a retrospective cohort analysis with routine data from 59 South African clinics. We included people living with HIV ≥15 years old receiving first-line tenofovir disoproxil fumarate, lamivudine, dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, efavirenz (TEE), and with first viraemia (≥50 copies/ml) between June to November 2020. We used multivariable modified Poisson regression models to compare retention-in-care and viral suppression (<50 copies/ml) after 12 months between participants on TLD versus TEE.

Results

At first viraemia, among 9657 participants, 6457 (66.9%) were female, median age was 37 years (interquartile range [IQR] 31-44); 7598 (78.7%) were receiving TEE and 2059 (21.3%) TLD. Retention-in-care was higher in the TLD group (84.9%) than TEE (80.8%), adjusted risk ratio (aRR) 1.03, 95%CI 1.00-1.06. Of 6569 participants retained in care and had a 12-month viral load, viral suppression was similar between TLD (78.9%) and TEE (78.8%) groups, aRR 1.02, 95%CI 0.98-1.05. However, 3368 participants changed ART during follow-up; the majority from TEE to first-line TLD (89.1%) or second-line (TLD 3.4%, zidovudine/emtricitabine/lopinavir-ritonavir 2.1%). In sensitivity analysis among the remaining 3980 participants who did not change ART during follow-up and had a 12-month viral load, viral suppression was higher in the TLD group (78.9%) than TEE (74.9%), aRR 1.07, 95%CI 1.03-1.12.

Conclusions

Among people with viraemia on first-line ART, dolutegravir was associated with better retention-in-care and similar or better viral suppression than efavirenz.
Association of blood pressure with cognitive impairment in elderly hypertensive patients in China: A cross-sectional study
Authors: Jia Yao , Qi Shige , Yin Peng , Zhou Maigeng , Ji Fusui , Wang Zhihui , Yu Xue
Published: August 2023

Aims

To investigate the prevalence of cognitive impairment among elderly Chinese patients with hypertension and explore the relationship between blood pressure and cognitive impairment. Additionally, the study examined the characteristics of cognitive impairment in hypertensive patients and its impact on blood pressure control.

Methods

A cross-sectional study was conducted involving 23,271 subjects. Data collection involved questionnaires, physical examinations, and blood tests. AD8 questionnaire, MMSE questionnaire, and neurologist interview, was used to screen patients for cognitive disabilities. Risk factors and prevalence of cognitive impairment were compared between hypertensive and non-hypertensive groups. The prevalence of cognitive impairment at different blood pressure levels was analyzed within the hypertension group. Differences in MMSE scores across dimensions were compared between hypertensive and non-hypertensive groups.

Results

The hypertensive group exhibited additional risk factors for cognitive impairment and a higher prevalence of cognitive impairment. The prevalence of cognitive impairment among hypertensive patients followed a U-shaped curve with increasing blood pressure, with the lowest rate observed among patients with blood pressure in the range of 120-139/80-89 mmHg. Several dimensions of cognitive function were significantly diminished in individuals with hypertension. Patients with cognitive impairment demonstrated lower compliance with hypertension treatment and poorer blood pressure control.

Conclusion

Cognitive decline across multiple dimensions is typical among older Chinese patients with hypertension, and cognitive impairment has detrimental effects on blood pressure management. Maintaining blood pressure in the 120-139/80-89 mmHg range appears to be more favorable for preserving cognitive function in hypertensive patients.
Physical and psychosocial consequences of falls in individuals with cerebral palsy
Authors: Thill Marissa , Krach Linda E. , Pederson Kari , Wandersee Nathan G. , Tierney Sandy Callen , Boyer Elizabeth R.
Published: August 2023

Aim

To quantify fall frequency, characteristics, injuries, and psychosocial impact across the lifespan and between Gross Motor Classification System (GMFCS) levels in cerebral palsy (CP).

Method

Ambulatory individuals with CP (201 adults) or minors’ caregivers (180) completed online surveys on falls and their physical and psychosocial consequences for this cross-sectional study.

Results

Almost everyone fell in the past year (86%); GMFCS level II fell most often. Having experienced serious fall-related injuries (e.g., head/face stitches, concussion) increased with age, affecting 80% of ≥50-year-olds. Forward falls caused by tripping during shod ambulation were common. Uneven surfaces and fatigue were notable causes. Concern about falling and associated activity avoidance was highest for GMFCS level III. Psychosocial consequences of falls (e.g., embarrassment, lost confidence) were elevated across GMFCS levels. Nearly everyone (88%) wished they fell less.

Interpretation

Fall frequency in ambulatory children and adults with CP is 2-3-fold higher than the general older adult population. Physical and psychosocial consequences of falls were frequent and impacted life choices. Differences observed by GMFCS level and age should be considered in care delivery. Clinically tracking and discussing falls and their repercussions across the lifespan will aid in addressing this under-researched and under-resourced concern of people with CP.

WHAT THIS PAPER ADDS

Among 381 individuals with CP, 86% fell in the past year.

Falling was most common among 5-12-year-olds and GMFCS level II.

Head/face stitches, fractures, sprained knee/ankle, and concussions were common serious injuries.

Participants experienced high levels of embarrassment, pain, and loss of confidence.

GMFCS level III had the greatest fall concern and avoidance behavior.
Anti-Hepatitis C Antibody Carriage and Risk of Liver Impairment in Rural-Cameroon: Adapting the Control of Hepatocellular Carcinoma for Resource-Limited Settings
Authors: Kamga Wouambo Rodrigue , Panka Tchinda Gaelle , Kagoue Simeni Luc Aime , Djouela Djoulako Paule Dana , Yateu Wouambo Clarisse Irene , Tamko Mella Ghislaine Flore , Tchoumi Leuwat Eric pascal , Bello Djoda , Fokam Joseph
Published: August 2023

Background

The global Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS.

Methods

A facility-based observational study was conducted from July-August 2021 among individuals attending the “St Monique” Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p<0.05 considered statistically significant.

Results

Out of 306 eligible participants (negative for HBsAg and HIVAb) enrolled, the mean age was 34.35±3.67 years. 252(82.35%) were female and 129 (42.17%) were single. The overall HCVAb sero-positivity was 15.68%(48/306), with 17.86% (45/252) among women vs. 5.55%(3/54) among men [OR (95%CI)=3.69(2.11-9.29),p=0.04]. HCVAb Carriage was greater among participants aged >50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI)=4.43(2.11-9.29), p<0.000] and in multipartnership [26.67%(12/45)vs.13.79%(36/261) monopartnership, OR (95%CI)= 2.27(1.07-4.80),p=0.03]. The liver impairment rate (abnormal ALT+AST levels) was 30.39%(93/306), with 40.19%(123/306) of abnormal ALT alone. Moreover, the burden of Liver impairment was significantly with aged>50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p<0.000). Interestingly, the burden of liver impairment (abnormal AST+ALAT) was significantly higher in HCVAb positive (62.5%, 30/48) versus HCVAb negative (24.42%, 63/258) participants, OR: 3.90 [1.96; 7.79], p=0.0001.

Conclusions

In this rural health facility, HCVAb is highly endemic and the burden of liver impairment is concerning. Interestingly, HCVAb carriage is associated with abnormal liver levels of enzyme (ALT/AST), especially among the elderly populations. Hence, in the absence of nuclei acid testing, ALT/AST are relevant sentinel markers to screen HCVAb carriers who require monitoring/care for HCV-associated hepatocellular carcinoma in RLS.
Offspring cardiometabolic outcomes and postnatal growth trajectories after exposure to maternal SARS-CoV-2 infection
Authors: Shook Lydia L. , Castro Victor M. , Herzberg Emily M. , Fourman Lindsay T. , Kaimal Anjali J. , Perlis Roy H. , Edlow Andrea G.
Published: August 2023

Context

Prior birth cohorts have suggested an association between maternal infection in pregnancy and offspring risk for childhood obesity. Whether maternal SARS-CoV-2 infection is similarly associated with increased cardiometabolic risk for offspring is not known.

Objective

To determine whether in utero exposure to SARS-CoV-2 is associated with increased risk for cardiometabolic diagnoses by 18 months after birth, compared with unexposed offspring born during the COVID-19 pandemic.

Design

This retrospective cohort study included the live offspring of all individuals who delivered during the COVID-19 pandemic (April 1, 2020 - December 31, 2021) at 8 hospitals within 2 health systems in Massachusetts.

Exposure

SARS-CoV-2 positivity on polymerase chain reaction (PCR) test during pregnancy.

Main Outcome Measures

Electronic health record documentation ofInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revisiondiagnostic codes corresponding to cardiometabolic disorders. Offspring weight-for-age, length-for-age, and body mass index (BMI)-for-age z-scores at birth, 6 months, 12 months, and 18 months of age.

Results

The full study cohort includes 29,510 live born offspring (1,599 exposed and 27,911 unexposed offspring). 6.7% of exposed and 4.4% of unexposed offspring had received a cardiometabolic diagnosis by 18 months of age (crude OR 1.47 [95% CI: 1.10-1.94], p=0.007; adjusted OR 1.37 [1.01-1.83]; p=0.04). These diagnoses were preceded by significantly greater mean BMI-for-age z-scores in exposed versus unexposed offspring at 6 months (mean z-score difference 0.19, 95% CI: 0.10, 0.29, p<0.001), and a greater proportion of offspring at risk of, or meeting criteria for, overweight/obesity (16.5% vs. 12.2%, p=0.006).

Conclusions

Exposure to maternal SARS-CoV-2 infection was associated with an increased risk of receiving a cardiometabolic diagnosis by 18 months and greater BMI-for-age at 6 months.
Association Between Diabetes Mellitus and Endodontic Pathosis
Authors: Strother Kortnie K. , Kookal Krishna Kumar , Bueso Vashti , Walji Muhammad F. , Letra Ariadne
Published: August 2023

Background

Studies have shown that periodontal and periapical diseases are more prevalent among diabetes mellitus (DM) patients. Here, we evaluated the potential relationship between endodontic pathologies and DM through a retrospective analysis of 2,000 electronic health records (EHR) of individuals with/without DM.

Methods

Records of patients treated at UTHealth School of Dentistry presenting with a history of endodontic treatment with and without DM were randomly selected for analysis of 24 treatment- and patient-centric variables to assess for the association between endodontic disease and DM. Data between groups were compared using Chi-square, Fisher Exact tests, and one-way analysis of variance (ANOVA). Significant differences were set at P<0.05.

Results

Diabetic patients had significantly less symptomatic pulpal diagnoses, particularly less symptomatic irreversible pulpitis (P<0.00005); whereas they had significantly more symptomatic apical periodontitis (P=0.01) than non-diabetics. Diabetics had a significantly greater number of endodontically-treated teeth (P=2.2 × 10−16), particularly canines and molars (P<0.002). The frequency of active periapical lesions was higher in non-diabetics, although no differences in lesion size were observed. The frequency of periodontal disease and additional systemic disease(s), and smoking was significantly increased in DM patients with endodontic treatment (P<0.05). No differences were observed between the number of medications taken between groups or upon stratifying analysis by gender (P>0.05).

Conclusions

Our results continue to support that DM contributes to increased endodontic disease and highlight the complex relationships between oral and systemic diseases.

Practical Implications

Dental professionals should be cognizant of endodontic pathology as a clinical complication of DM that presents as more chronic in nature, at a greater frequency, and have a tendency toward a nonhealing outcome.
CHANGES IN CORNEAL ABERRATIONS IN PATIENTS WITH CATARACT SURGERY WITH TORIC LENS IMPLANT: AN EXPLORATORY REVIEW
Authors: Assis Jorge Karim , Montaño Luisa Fernanda , Quintero DAniela Tutal , Giraldo Simon
Published: August 2023

Introduction

The cataract is one of the main causes of visual alterations, which is normally treated with surgery since it improves the visual acuity of the patients, the object of the present investigation is to synthesize evidence on how the surgical intervention affects or changes the corneal aberrations.

Methodology

conducted an exploratory review of the literature, observational studies on changes in corneal aberrations after cataract surgery with toric lens implant, using Pubmed, Google Scholar, Lilacs, Scopus, and Science Direct, searching and selecting articles from blindly and independently, following the PRISMA methodology.

Results

The body of evidence selected was 4 articles published in a 6-year window, between 2011 and 2016. The average age of the surgically operated population was 65.3 ± 7.7 years, while the proportion according to sex there was a similar and greater change in corneal aberrations due to coma and trefoil.

Conclusions

surgery with an incision equal to or less than 2.2 mm induces slight changes in the aberration of the total cornea, which increase before in eyes with a high pre-existence of corneal astigmatism and it is independent if the lens is toric or not.
Evidence for increased fitness of a plant pathogen conferred by epigenetic variation
Authors: Gopalan-Nair Rekha , Coissac Aurore , Legrand Ludovic , Lopez-Roques Céline , Pécrix Yann , Vandecasteele Céline , Bouchez Olivier , Barlet Xavier , Lanois Anne , Givaudan Alain , Brillard Julien , Genin Stéphane , Guidot Alice
Published: August 2023

Adaptation is usually explained by adaptive genetic mutations that are transmitted from parents to offspring and become fixed in the adapted population. However, more and more studies show that genetic mutation analysis alone is not sufficient to fully explain the processes of adaptive evolution and report the existence of non-genetic (or epigenetic) inheritance and its significant role in the generation of adapted phenotypes. In the present work, we tested the hypothesis of the role of DNA methylation, a form of epigenetic modification, in adaptation of the plant pathogenRalstonia solanacearumto the host plant during an experimental evolution. Using SMRT-seq technology, we analyzed the methylomes of 31 experimentally evolved clones that were obtained after serial passages on a given host plant during 300 generations, either on susceptible or tolerant hosts. Comparison with the methylome of the ancestral clone revealed between 12 and 21 differential methylated sites (DMSs) at the GTWWAC motif in the evolved clones. Gene expression analysis of the 39 genes targeted by these DMSs revealed limited correlation between differential methylation and differential gene expression. Only one gene showed a correlation, the RSp0338 gene encoding the EpsR regulator protein. The MSRE-qPCR (Methylation Sensitive Restriction Enzyme - qPCR) technology was used as an alternative approach to assess the methylation state of the DMSs found by SMRT-seq between the ancestral and evolved clones. This approach also found the two DMSs upstream of RSp0338. Using site-directed mutagenesis, we demonstrated the contribution of these two DMSs in host adaptation. As these DMSs appeared very quickly in the experimental evolution, we hypothesize that such fast epigenetic changes can allow rapid adaptation to the plant stem environment. To our knowledge, this is the first study showing a link between epigenetic variation and evolutionary adaptation to new environment.
Prevalence and risk factors of self-reported hearing and balance dysfunction in a population-based sample from rural northeastern Germany
Authors: Ihler Friedrich , Brzoska Tina , Altindal Reyhan , Dziemba Oliver , Voelzke Henry , Busch Chia-Jung , Ittermann Till
Published: August 2023

Objectives. A close anatomical and physiological relationship is known between the senses of hearing and balance, while an additional pathophysiological interaction is supposed. The pathophysiological mechanisms underlying this association are not fully understood, especially in individuals without a known specific otologic disorder. Therefore, further insight is required into the prevalence of the audiovestibular symptoms hearing loss, tinnitus and dizziness as only scarce information on the combined occurrence is available so far. Additionally, the influence of potential risk factors from lifestyle habits as well as cardiovascular and metabolic conditions on the development of those symptoms should be studied. Design. To evaluate the prevalence of self-reported hearing loss, tinnitus and dizziness in two separate population-based samples from Western Pomerania, a rural region of north-eastern Germany. Datasets from 8134 individuals aged 20 to 79 years were available from the baseline investigations of the cohorts START and TREND of the Study of Health in Pomerania (SHIP). Audiovestibular symptoms were assessed by structured questionnaires. The cohorts were comprehensively characterized regarding modifiable lifestyle factors as well as cardiovascular and metabolic disorders, allowing the assessment of the role of those influencing factors. Results. We observed a weighted prevalence of 14.2% for hearing loss, 9.7% for tinnitus and 13.5% for dizziness in the population. The prevalence increased with age and differed among the sexes. A relevant subgroup of 28.0% of affected individuals reported more than one symptom. The prevalence of hearing loss as well as tinnitus increased between the two cohorts. A moderate positive correlation was found between hearing loss and tinnitus (phi-coefficient 0.318). In multivariable regression analyses, education was identified as a significant protective factor while only smoking was significantly associated with all three symptoms. Furthermore, several cardiovascular risk factors contributed to both hearing loss and dizziness. Conclusions. Audiovestibular symptoms are highly prevalent in the general population. A considerable but complex influence of risk factors points towards a relation with neuronal as well as cardiovascular disease processes. To clarify the underlying mechanisms, the interaction between the senses of hearing and balance as well as the mode of action of the risk factors should be evaluated in more detail in the future.
MDMA Assisted Psychotherapy Decreases PTSD Symptoms, Dissociation, Functional Disability, and Depression: A Systematic Review and Meta-Analysis
Authors: Green W. M. , Raut S.B. , James F.L.J. , Benedek D.M. , Ursano R.J. , Johnson L.R.
Published: August 2023

Post-Traumatic Stress Disorder (PTSD) causes broad impairments affecting quality of life. However, despite current treatment many people with PTSD do not fully recover. MDMA assisted psychotherapy has emerged as a new therapy for PTSD and its comorbidities. We aimed to analyse the current evidence for MDMA assisted psychotherapy in PTSD and associated quality of life, and physiological effects, by conducting a systematic review and metanalysis of randomised controlled trials. ClinicalTrials.gov, MEDLINE, PsycINFO, PsycARTICLES, and Cochrane Library database were searched from inception to July 2022. We included both published and unpublished randomized control trials comparing MDMA assisted psychotherapy (MDMA-AP) with control. Meta-analysis of primary and secondary outcome measures was performed using Review-Manager software. Effect sizes were calculated using Standardised Mean Difference for CAPS scores and Mean Difference for secondary measures. MDMA-AP significantly improves dissociation, depression, and functional impairment, compared to controls, but not sleep quality. This data supports the use of MDMA-AP for PTSD with an improvement found in PTSD core symptoms and quality of life measures. While these findings are limited by small samples sizes in currently available clinical trials, this study provides empirical evidence to support development of MDMA-AP in PTSD.
Adjusting for the progressive digitization of health records: working examples on a multi-hospital clinical data warehouse
Authors: Remaki Adam , Playe Benoît , Bernard Paul , Vittoz Simon , Doutreligne Matthieu , Chatelier Gilles , Audureau Etienne , Kempf Emmanuelle , Porcher Raphaël , Bey Romain
Published: August 2023

Abstract

Objectives

To propose a new method to account for time-dependent data missingness caused by the increasing digitization of health records in the analysis of large-scale clinical data.

Materials and Methods

Following a data-driven approach we modeled the progressive adoption of a common electronic health record in 38 hospitals. To this end, we analyzed data collected between 2013 and 2022 and made available in the clinical data warehouse of the Greater Paris University Hospitals. Depending on the category of data, we worked either at the hospital, department or unit level. We evaluated the performance of this model with a retrospective cohort study. We measured the temporal variations of some quality and epidemiological indicators by successively applying two methods, either a naive analysis or a novel complete-source-only analysis that accounts for digitization-induced missingness.

Results

Unrealistic temporal variations of quality and epidemiological indicators were observed when a naive analysis was performed, but this effect was either greatly reduced or disappeared when the complete-source-only method was applied.

Discussion

We demonstrated that a data-driven approach can be used to account for missingness induced by the progressive digitization of health records. This work focused on hospitalization, emergency department and intensive care units records, along with diagnostic codes, discharge prescriptions and consultation reports. Other data categories may require specific modeling of their associated data sources.

Conclusions

Electronic health records are constantly evolving and new methods should be developed to debias studies that use these unstable data sources.
Efficacy and Viral Dynamics of Tecovirimat in Patients with MPOX: A Multicenter Open-Label, Double-Arm Trial in Japan
Authors: Akiyama Yutaro , Morioka Shinichiro , Tsuzuki Shinya , Yoshikawa Tomoki , Yamato Masaya , Nakamura Hideta , Shimojima Masayuki , Takakusaki Mizue , Saito Sho , Takahashi Kozue , Sanada Mio , Komatsubara Mika , Takebuchi Kahoru , Yamaguchi Etsuko , Suzuki Tetsuya , Shimokawa Komei , Kurosu Takeshi , Kawahara Madoka , Oishi Kohei , Ebihara Hideki , Ohmagari Norio
Published: August 2023

Introduction

Tecovirimat’s application in treating mpox remains under-researched, leaving gaps in clinical and virological understanding.

Methods

The Tecopox study, conducted in Japan, assessed the efficacy and safety of oral tecovirimat therapy in patients with smallpox or mpox. Patients with mpox enrolled between June 28, 2022, and April 30, 2023, were included. We gathered demographic and clinical details along with blood, urine, pharyngeal swab, and skin lesion samples for viral analysis. A multivariable Tobit regression model was employed to identify factors influencing prolonged viral detection.

Results

Nineteen patients were allocated to the tecovirimat group. The median age was 38.5 years, and all were male. Ten patients (52.6%) were infected with the human immunodeficiency virus (HIV). Sixteen patients (84.2%) had severe disease. Nine of the 15 patients (60.0%) (four patients withdrew before day 14) had negative PCR results for skin lesion specimens 14 days after inclusion. The mortality rates on days 14 and 30 were 0% and 0%, respectively. No severe adverse events were reported. HIV status and the number of days from symptom onset to tecovirimat administration were associated with lower Ct values (p= 0.027 and p < 0.001, respectively). The median number of days when PCR testing did not detect the mpox virus in each patient was 19.5 days.

Conclusion

The results suggest that early tecovirimat administration might reduce viral shedding duration, thereby mitigating infection spread. Moreover, patients infected with HIV appeared to have prolonged viral shedding, increasing the transmission risk compared to those without HIV.

Keypoints

The Tecopox study revealed that early tecovirimat administration might reduce viral shedding duration, thereby mitigating infection spread. Moreover, patients infected with HIV appeared to have prolonged viral shedding, increasing the transmission risk compared to those without HIV.
Personalized coronary and myocardial blood flow models incorporating CT perfusion imaging and synthetic vascular trees
Authors: Menon Karthik , Khan Muhammed Owais , Sexton Zachary A. , Richter Jakob , Nieman Koen , Marsden Alison L.
Published: August 2023

Computational simulations of coronary artery blood flow, using anatomical models based on clinical imaging, are an emerging non-invasive tool for personalized treatment planning. However, current simulations contend with two related challenges – incomplete anatomies in image-based models due to the exclusion of arteries smaller than the imaging resolution, and the lack of personalized flow distributions informed by patient-specific imaging. We introduce a data-enabled, personalized and multi-scale flow simulation framework spanning large coronary arteries to myocardial microvasculature. It includes image-based coronary models combined with synthetic vasculature for arteries below the imaging resolution, myocardial blood flow simulated using Darcy models, and systemic circulation represented as lumped-parameter networks. Personalized flow distributions and model parameters are informed by clinical CT myocardial perfusion imaging and cardiac function using surrogate-based optimization. We reveal substantial differences in flow distributions and clinical diagnosis metrics between the proposed personalized framework and empirical methods based on anatomy; these errors cannot be predicted a priori. This suggests virtual treatment planning tools would benefit from increased personalization informed by emerging imaging methods.
A Retrospective Cohort Study of the 2018 Angiotensin Receptor Blocker (ARB) Recalls and Subsequent Drug Shortages on Patients with Hypertension
Authors: Devine Joshua W , Tadrous Mina , Hernandez Inmaculada , Callaway Kim Katherine , Rothenberger Scott D , Mukhopadhyay Nandita , Gellad Walid F , Suda Katie J
Published: August 2023

Purpose

In July 2018, the Food and Drug Administration recalled valsartan due to carcinogenic impurities, leading to an unprecedented drug shortage leading to management challenges impacting a large population of valsartan users. However, the extent to which the valsartan recall impacted clinical outcomes is unknown. Our objective was to compare the risk of adverse events between patients with hypertension using valsartan and a propensity-score-matched group of patients using non-recalled angiotensin receptor blockers (ARBs) and angiotensin converting enzyme-inhibitors (ACE-Is).

Methods

We conducted a retrospective cohort analysis of Optum’s de-identified Clinformatics® Datamart (July 2017–January 2019). Adults with hypertension who received valsartan were compared to persons who received non-recalled ARBs and ACE-Is for 1 year prior to and on the recall date. The primary outcomes were measured in the 6 months following the recall date included: 1) a composite measure of all-cause hospitalization, all-cause emergency department (ED) and all-cause urgent care (UC) visit, 2) a composite cardiac event measure of hospitalizations for acute myocardial infarction and hospitalizations/ED/UC visits for stroke/transient ischemic attack, heart failure or hypertension. Cox proportional hazard models compared the risk of outcomes between propensity-score-matched treatment groups.

Results

Of adults with hypertension, 76,934 received valsartan at the time of the recall and 509,742 received a non-recalled ARB/ACE-I. Valsartan use at the time of the recall was associated with a combined increased risk of all-cause hospitalization, ED or UC use (HR 1.02; 95% CI: 1.00–1.04) and of the composite of cardiac events (HR 1.22; 95% CI: 1.15–1.29) within six-months after the recall.

Conclusions

The national valsartan recall and subsequent shortage had negative consequences for patients with hypertension. As the threat of shortages increases for drugs that treat common outpatient conditions, systems at the local- and national-levels need to be strengthened to protect patients from drug shortages by providing them with safe and reliable alternatives.