bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of immunoglobulin M (IgM), IgG, and IgA antibodies against Yersinia enterocolitica by enzyme-linked immunosorbent assay: persistence of serum antibodies during disease
Authors: Granfors K
Published: June 2021

An enzyme-linked immunosorbent assay for the detection and quantitation of human immunoglobulin M (IgM), IgG, and IgA antibodies against Yersinia enterocolitica is described. Formalinized or heat-treated bacteria were adsorbed onto specially designed microcuvettes, and antibodies were allowed to attach to the antigen-coated cuvettes. Rabbit anti-human mu, anti-human gamma, and anti-human alpha antisera were allowed to react with human antibodies, and these class-specific anti-immunoglobulins were detected by alkaline phosphatase-labeled swine anti-rabbit IgG. A total of 423 sera were tested. The results obtained with the enzyme-linked immunosorbent assay were compared with the results of the conventional tube agglutination test. Persistence of different antibodies was studied in six patients. Antibodies of the IgM class persisted only for 1 to 3 months after onset of the disease; thus the occurence of IgM-class Yersinia antibodies in a single sample indicates a recently acquired infection. The persistence of the IgG- and IgA-class antibodies was variable and not parallel with each other. Remarkably, all three patients in which the disease was complicated with arthritis had IgA-class Yersinia antibodies at the end of the follow-up period of 9 to 14 months, and in those without arthritis the IgA-class antibodies disappeared within 3 months after onset of the disease.
False-positive reactions in the rapid plasma reagin-card, fluorescent treponemal antibody-absorbed, and hemagglutination treponemal syphilis serology tests
Authors: Peter C R , Thompson M A , Wilson D L
Published: June 2021

Sera from 628 nonsyphilitic individuals were tested with the Rapid Plasma Reagin-Card, Fluorescent Treponemal Antibody-Absorbed, and Hemagglutination Treponemal Test for Syphilis tests to ascertain the comparative specificity of these tests. Many sera were also tested with the quantitative Venereal Disease Research Laboratory test. Sera included in the study were from both normal individuals and patients with a variety of illnesses and conditions. The Hemagglutination Treponemal Test for Syphilis gave the lowest overall percentage of false-positive reactions (1.6%), followed by the Fluorescent Treponemal Antibody-Absorbed test (3.3%) and the Rapid Plasma Reagin-Card test (10.8%).
Improved blood culture technique based on centrifugation: clinical evaluation
Authors: Dorn G L , Land G A , Wilson G E
Published: June 2021

A total of 3,335 blood samples from 1,180 patients suspected of having bacteremia were analyzed concurrently by two methods: (i) supplemented peptone broth with sodium polyanethanol sulfonate and a CO2 atmosphere; and (ii) lysis centrifugation at 3,000 X g for 30 min onto a high-density, hydrophobic cushion. The centrifugation technique recovered 80% of the positive cultures as compared with 67% for the broth method. The centrifugation technique showed an apparent increase in the isolation of staphylococcus aureus, Pseudomonas, and yeasts. In almost every instance, the time required for detection of a positive culture was shortest for the centrifugation method. Contamination rates for both systems were comparable (1.4%). Quantitation, offered only by the centrifugation method, proved useful on several occasions in discriminating between an opportunistic infection versus a skin contaminant and in judging efficacy of antimicrobial therapy.
Production of high-titer bovine rotavirus with trypsin
Authors: Clark S M , Barnett B B , Spendlove R S
Published: June 2021

Titers of bovine rotavirus in excess of 10(9) immunofluorescent infectious units per ml of culture fluids have been produced, using trypsin treatment of the virus. Infectivity of preparations of the virus can be increased with as little as 1 ng of trypsin per ml, with maximum increases of 1 to 2 log10 with 1 microgram of trypsin per ml. The virus grows to titers in excess of 10(5) immunofluorescent units per ml in MDBK, LLC-MK2, MA-104, and HeLa cells. When MDBK cells are infected with a multiplicity of infection of 20, maximum yields of cell-associated, trypsin-enhanceable virus are obtained 4 to 8 h postinfection. Maximum yields of cell-free, trypsin-enhanceable virus are produced 16 to 20 h postinfection. The results presented here indicate that trypsin can be used to produce high-titer stocks of bovine rotavirus.
Achromobacter species (CDC group Vd): morphological and biochemical characterization
Authors: Chester B , Cooper L H
Published: June 2021

Twenty-three isolates of Achromobacter species (CDC group Vd) were examined morphologically and biochemically. Gram stains revealed gram-variable bacilli frequently curved or hooked at one pole and often coryneform in shape and arrangement. Electron microscopy revealed the presence of extracellular material in polar accumulations and demonstrated the polar flagella arrangement seen by light microscopy to be lateral. Two colony types were produced; one was minute and watery at 24 h (35 degrees C) progressing to large, mucoid colonies at 48 h, and the other type was shiny, glistening, opaque but nonmucoid. All isolates grew on MacConkey agar and produced catalase, oxidase, and urease. Most grew on salmonella-shigella agar, reduced nitrate to nitrite and gas, hydrolyzed esculin, deaminated phenylalanine (2 to 4 days) and produced H2S in triple sugar iron agar (4 to 12 days). Oxidation of carbohydrates was weak, delayed, and limited to glucose and xylose. Two isolates also oxidized maltose, mannitol, and sucrose. The ability of miniaturized "nonfermenter" kits to identify Achromobacter species was tested. The Minitek (Baltimore Biological Laboratory, Cockeysville, Md.) and N/F (Corning, Roslyn, N.Y.) systems, respectively, identified 21 and 19 of the 23 isolates, whereas the Oxi/Ferm (Roche, Nutley, N.J.) identified 13 and the API 20E (Analytab Products, Plainview, N.Y.) identified only 3.
Isolation of Legionella pneumophila from a transtracheal aspirate
Authors: Edelstein P H , Finegold S M
Published: June 2021

Isolation of Legionella pneumophila from a transtracheal aspirate was achieved by using simple in vitro culture methods. Clinical microbiologists should routinely culture for this organism from appropriate body fluids obtained from normally sterile areas.
Use of 2-aminoacetophenone production in identification of Pseudomonas aeruginosa
Authors: Cox C D , Parker J
Published: June 2021

A grapelike odor is often of diagnostic importance in detecting the growth of Pseudomonas aeruginosa in culture and in burn wounds. The compound responsible for the odor has been identified as 2-aminoacetophenone by mass spectroscopy. Although the grape odor is sometimes difficult to detect in culture media, gas chromatographic, fluorometric, and colorimetric methods can be utilized to assay 2-aminoacetophenone production in a variety of media. Its synthesis occurs relatively early in the growth cycle. It has proved easy and convenient to detect 2-aminoacetophenone excretion by P. aeruginosa after 24 h of incubation on blood agar plates employing a fluorometric assay of ether extracts of the agar medium.
Immunoglobulin G- and M-specific enzyme-linked immunosorbent assay for detection of dengue antibodies
Authors: Dittmar D , Cleary T J , Castro A
Published: June 2021

An enzyme-linked immunosorbent assay for the detection of antibodies to dengue virus is described. This method correlates well with a hemagglutination inhibition technique. The enzyme-linked immunosorbent assay can also be specific for human immunoglobulin M antibodies when a mu-chain-specific antiglobulin-enzyme conjugate and fractionated serum are employed. By using this technique, dengue immunoglobulin M antibodies were demonstrated in an infant suspected of having a recent dengue infection.
Pseudomonas paucimobilis from a leg ulcer on a Japanese seaman
Authors: Peel M M , Davis J M , Armstrong W L , Wilson J R , Holmes B
Published: June 2021

Pseudomonas paucimobilis was isolated in pure culture from an ulcer on the leg of a Japanese seaman while in an Australian port. A description of the isolate is given. This may be the first report of a human infection in which this recently characterized species is implicated as a pathogen.
Broth dilution minimum inhibitory concentrations: rationale for use of selected antimicrobial concentrations
Authors: Witebsky F G , Maclowry J D , French S S
Published: June 2021

A microdilution susceptibility testing procedure utilizing selected, clinically relevant concentrations of a large number of antimicrobial agents is described. A qualitative code designed to facilitate interpretation of quantitative results is coupled with each antimicrobial concentration. Both the antimicrobial concentrations selected for testing and the assigned codes are based on published data regardling attainable antimicrobial levels in serum and urine.
Reliability of a single urine culture in establishing diagnosis of asymptomatic bacteriuria in adult males
Authors: Gleckman R , Esposito A , Crowley M , Natsios G A
Published: June 2021

Fifty-nine asymptomatic men without catheters of ileal-loop bladders, who were attending a urology clinic and were incidentally discovered to have 100,000 or more Enterobacteriaceae per ml ("significant bacteriuria") in a clean voided urine sample, were prospectively evaluated. To identify these 59 patients, 5,876 urine samples, collected exclusively from men, had been subjected to quantitation and identification. A repeat urine culture performed on these patients invariably confirmed the results of the initial culture. The reproducibility of a single urine culture containing significant bacteriuria occurred independently of the tissue source of infection, as determined by the antibody-coated-bacteria immunofluorescence test. We conclude that a single urine culture obtained from a cooperative man can establish the diagnosis of asymptomatic bacteriuria.
Comparison of Micro-ID and API 20E systems for identification of Enterobacteriaceae
Authors: Blazevic D J , Mackay D L , Warwood N M
Published: June 2021

The Micro-ID 4-h identification system for Enterobacteriaceae was compared to the API 20E overnight method, using 230 fresh clinical isolates and 74 stock cultures. Agreement was 97.8% for the clinical isolates and 93.2% for the stock cultures. Eighty-seven percent of primary culture plates containing gram-negative rods yielded sufficient growth to perform the 4-h Micro-ID identification on the same day the organisms were isolated.
Development of dengue virus plaques under serum-free overlay medium
Authors: Malewicz B , Jenkin H M
Published: June 2021

An improved plaque assay for dengue virus was developed utilizing baby hamster kidney (BHK-21) cells initially grown in shaker culture. Different media preparations were tested for uniform and fast formation of BHK-21 cell sheets. Several overlay formulas were tested to develop a rapid plaque assay in 6- and 24-well plastic plates. The best results were obtained utilizing Eagle minimal essential medium (pH 7.2 to 7.4) supplemented with 1 mg of NaHCO3 per ml and 5% newborn calf serum for the formation of cell monolayers after 8 to 24 h of incubation at 37 degrees C. Serum-free Eagle minimal essential medium supplemented with 1% methylcellulose and buffered with 10 mM N-2-hydroxyethyl piperazine-N'-2-ethanesulfonic acid (pH 7.4 to 7.6) was used as an overlay medium. This system allowed for plaque formation after 3 days of incubation of dengue type 2 virus and after 4 days for dengue type 1 and 4 viruses.
Selective medium for Corynebacterium equi isolation
Authors: Woolcock J B , Farmer A M , Mutimer M D
Published: June 2021

The development of a selective medium for the isolation of Corynebacterium equi is described. The medium has been used to examine fecal samples from 127 horses of which 90 have been found to carry the organism.
Diagnosis of Mycoplasma hominis pyelonephritis by demonstration of antibodies in urine
Authors: Thomsen A C , Lindskov H O
Published: June 2021

To evaluate the diagnostic significance of the demonstration in urine of antibodies to Mycoplasma hominis, 1,000 samples of urine with more than 5 leukocytes per high-power field were serologically investigated by indirect hemagglutination, using glutaraldehyde-fixed erythrocytes coated with M. hominis antigen. The samples were collected from 702 patients. Antibodies were demonstrated in the urine of nine patients, all of whom had signs of acute attack of pyelonephritis. In seven of these patients, characterized by mild or moderate clinical signs and absence of lower urinary tract symptoms, bacterial causes were not observed, whereas M. hominis organisms were isolated from the upper urinary tract in most cases and from the bladder urine in all cases. In two patients, characterized by severe clinical signs and presence of lower urinary tract symptoms, both M. hominis and bacteria were isolated from the upper urinary tract and ballder urine. The demonstration of antibodies to M. hominis in urine is of high diagnostic value as they were only observed in patients in whom M. hominis infection in the upper urinary tract was evident or likely and only in the presence of clinical signs of acute attacks of pyelonephritis.
Efficacy of cold enrichment techniques for recovery of Yersinia enterocolitica from human stools
Authors: Pai C H , Sorger S , Lafleur L , Lackman L , Marks M I
Published: June 2021

Stool specimens from children with gastroenteritis and their household contacts were cultured for Yersinia enterocolitica by direct plating onto routine laboratory media. These stools were also inoculated into phosphate-buffered saline and subcultured to the same media after 1 day or 3 weeks of incubation at 4 degrees C. Y. enterocolitica was isolated from 174 index cases and 34 household contacts. One hundred eighty-one isolates were of serotype O:3, and the remaining 21 belonged to other serotypes. Eighty-one percent (147/181) of O:3 isolates were recovered by direct plating, and 6.1% (11/181) and 13% (23/181) were recovered by 1-day and 3-week cold enrichment, respectively. For other serotypes, 26% (7/27), 0%, and 74% (20/27) were isolated by direct plating, 1-day cold enrichment, and 3-week cold enrichment, respectively. The efficacy of the cold enrichment for the patients were still symptomatic, 94 and 6% of Y. enterocolitica were identified by direct plating and cold enrichment, respectively. Isolation rates were 66% by direct plating and 34% by cold enrichment when stools were obtained from asymptomatic carriers or from those convalescing from Y. enterocolitica gastroenteritis. These results indicate that the cold enrichment methods increase the sensitivity of Y. entercolitica culture methods considerably in convalescent and asymptomatic subjects but only minimally in patients with diarrhea caused by serotype O:3.
Adapting a Bacterial Unknowns Project to Online Learning: Using Microsoft PowerPoint To Create an Unknowns Identification Simulation
Authors: Rhodes DeLacy V. L. , Barshick Madison R.
Published: June 2021

The COVID-19 pandemic forced institutions to move to online learning abruptly during the spring 2020 semester. As a result of this swift change, many microbiology laboratory courses chose to switch all in-class learning activities to simulations.
Generation of a new adenovirus type 12-inducible fragile site by insertion of an artificial U2 locus in the human genome
Authors: Li Y P , Tomanin R , Smiley J R , Bacchetti S
Published: June 2021

Infection with adenovirus type 12 (Ad12) induces four fragile sites in the human genome (H.F. Stich, G.L. van Hoosier, and J.J. Trentin, Exp. Cell Res. 34:400-403, 1964; H. zur Hausen, J. Virol. 1:1174-1185, 1967). The major site, at 17q21-22, contains the U2 gene cluster, which is specifically disrupted by infection in at least a percentage of the cells (D.M. Durnam, J.C. Menninger, S.H. Chandler, P.P. Smith, and J.K. McDougall, Mol. Cell. Biol. 8:1863-1867, 1988). For direct assessment of whether the U2 locus is the target of the Ad12 effect, an artificial locus, constructed in vitro and consisting of tandem arrays of the U2 6-kbp monomer, was transfected into human cells. We report that integration of this artificial locus on the p arm of chromosome 13 creates a new Ad12-inducible fragile site.
CCL19 and CCL28 Assist Herpes Simplex Virus 2 Glycoprotein D To Induce Protective Systemic Immunity against Genital Viral Challenge
Authors: Yan Yan , Hu Kai , Fu Ming , Deng Xu , Luo Sukun , Tong Lina , Guan Xinmeng , He Siyi , Li Chang , Jin Wei , Du Tao , Zheng Zifeng , Zhang Mudan , Liu Yalan , Hu Qinxue
Published: June 2021

An effective HSV-2 vaccine should induce antigen (Ag)-specific immune responses against viral mucosal infection. This study reveals that chemokine CCL19 or CCL28 enhanced HSV-2 glycoprotein D ectodomain (gD-306aa)-induced immune responses against vaginal virus challenge.
Cryptic β-Lactamase Evolution Is Driven by Low β-Lactam Concentrations
Authors: Fröhlich Christopher , Gama João A. , Harms Klaus , Hirvonen Viivi H. A. , Lund Bjarte A. , van der Kamp Marc W. , Johnsen Pål J. , Samuelsen Ørjan , Leiros Hanna-Kirsti S.
Published: June 2021

Very low antibiotic concentrations have been shown to drive the evolution of antimicrobial resistance. While substantial progress has been made to understand the driving role of low concentrations during resistance development for different antimicrobial classes, the importance of β-lactams, the most commonly used antibiotics, is still poorly studied.
A Peek into the Plasmidome of Global Sewage
Authors: Kirstahler Philipp , Teudt Frederik , Otani Saria , Aarestrup Frank M. , Pamp Sünje Johanna
Published: June 2021

This is, to the best of our knowledge, the first study to investigate plasmidomes at a global scale using long read sequencing from complex untreated domestic sewage. Previous metagenomic surveys have detected AMR genes in a variety of environments, including sewage.
Juvenile Hormone-Sensitive Ribosomal Activity Enhances Viral Replication in Aedes aegypti
Authors: Shi Zuo-Kun , Wen Dan , Chang Meng-Meng , Sun Xiao-Mei , Wang Yan-Hong , Cheng Chi-Hang , Zhang Li-Qin , Zheng Ai-Hua , Zou Zhen
Published: June 2021

Most flaviviruses are transmitted between hosts by arthropod vectors such as mosquitoes. Since therapeutics or vaccines are lacking for most mosquito-borne diseases, reducing the mosquito vector competence is an effective way to decrease disease burden.
Erosion of the Himalaya-Karakoram recorded by Indus Fan deposits since the Oligocene
Authors: Feng Han , Lu Huayu , Carrapa Barbara , Zhang Hanzhi , Chen Jun , Wang Ying , Clift Peter D.
Published: June 2021

The Cenozoic erosion history of the Himalaya-Karakoram, which is a function of tectonically driven uplift and monsoon climatic evolution in South Asia, remains elusive, especially prior to the Miocene. Here, we present a multiproxy geochemical and thermochronological analysis of the oldest samples available from the Arabian Sea, which we used to investigate the erosion history of the Himalayan and Karakoram orogenic system. The Indus Fan records rapid and sustained erosion of the Himalayan-Karakoram mountains from before 24 Ma (ca. 30) to ca. 16 Ma concurrent with changing provenance from the Indian (Himalayan) and Eurasian plates. Our data, combined with previous studies of younger Indus Fan deposits, indicate that the mid-to-late Cenozoic erosion history of the Himalayan-Karakoram mountains is overall consistent with a vigorous monsoonal climate from the late Oligocene to middle Miocene and with changes in global climate in the late Miocene, whereas erosion and deposition are relatively insensitive to changes in sources and rock erodibility. Although tectonic processes were active throughout, we suggest that the erosional signatures of the Himalayan-Karakoram mountains from the Indus Fan largely preserve a record of climate changes since the Oligocene.
Supplemental Material: Long-term Aptian marine osmium isotopic record of Ontong Java Nui activity
Authors: Matsumoto Hironao , al. et
Published: June 2021

Description of lithology and methods, Figure S1 (sampling site), Figure S2 (cross plots of δ13Ccarb and δ18Ocarb), Figure S3 (Re-Os data), Figure S4 (age-depth model), Table S1 (raw δ13Ccarb and δ18Ocarb data), Table S2 (raw Re-Os data), and Table S3 (age model).
The Influence of a Magnetic Storm on Tectonic Deformations and the Coast Effect
Authors: Sobolev G. A.
Published: June 2021

Records of 58 identical broadband seismograph stations were studied made during strong geomagnetic storms. Oscillations of periods of a few hours were studied. These were compared with synchronous variations of earth tides. Anomalous changes in deformation rate were observed after storms at stations installed near continent–ocean boundaries. They lasted a few days and had amplitudes of a few millimeters per minute.
Report of rapid diagnosis and precise management ofMMADHC-related intracellular cobalamin defect
Authors: Bhat Vivekananda , Narayanan Dhanya Lakshmi , Shukla Anju
Published: June 2021

Disorders of intracellular cobalamin metabolism are a group of metabolic disorders that lead to varied clinical presentation from intrauterine life to adulthood. We report a male infant with developmental regression, macrocytic anaemia and hyperpigmentation. Exome sequencing identified a homozygous pathogenic variant in theMMADHCgene, known to cause homocystinuria, cblD type (MIM #277410). We describe significant clinical improvement with targeted therapy and emphasise the relevance of genomic testing in accurate management of inherited metabolic disorders.
Pseudomyxoma retroperitonei masquerading as a psoas abscess
Authors: Badhe Padma Vikram , Ravi Kiran Dasari , Seshadri Harini
Published: June 2021

A 52-year-old woman was referred to our department with multiple discharging sinuses and swelling in the right flank and iliac region for the past year. Ultrasound revealed a large collection in the right psoas muscle with the sinus tract reaching up to the skin in the right iliac region. Despite repeated attempts at drainage, the collection continued to increase in size. CT was requested and revealed a large heterogeneous irregular collection in the right psoas with fistulous communication with the cecum and skin with the erosion of the overlying ilium. Because of lack of vertebral involvement, enhancing internal septations, non-visualisation of the appendix and feculent material admixed with mucinous discharge from the sinus, pseudomyxoma retroperitonei secondary to ruptured mucinous neoplasm of the appendix was suspected. Mucoid material at the local site was sent for histopathology, which confirmed our suspicion. Our treatment plan after ileostomy was cytoreductive surgery along with adjuvant radiotherapy (40 Gy in 20 fractions) with chemotherapy (5-fluorouracil and folinic acid given for 30 weeks, once a week). However, after ileostomy, the patient refused further treatment, citing financial reasons.
Right ventricular outflow obstruction with squamous cell carcinoma of unknown origin
Authors: Nakamura Ken , Kawahito Koji , Amagaya Suguru
Published: June 2021

A 60-year-old man was referred to our hospital because of chest tightness. CT scans showed no specific findings except a right ventricular (RV) mass. Echocardiogram revealed that the large cardiac mass was compressing the right ventricular outflow tract, and the patient thus underwent an emergency operation. As the tumour on the inlet side of the right ventricle was tightly adhered to the entire tricuspid chordae, a complete resection was impossible. Pathological findings revealed that the tumour was metastatic squamous cell carcinoma. Four cycles of chemotherapy were administered. Further investigations were conducted to identify the primary cancer focus, but there were no specific findings. Eight months after the operation, the patient returned to the hospital. Echocardiogram showed a severely occupying mass once again, and the patient died as a result. Autopsy revealed no findings relating to the primary origin of the cardiac metastases.
Surgical management of a COVID-19-associated necrotic pneumonia
Authors: Nizami Maria , Grieco Charlotte , Hogan John , Aresu Giuseppe
Published: June 2021

At the outset of the pandemic, SARS-CoV-2 was thought to present simply as persistent cough and fever. However, with time, the medical community noted a myriad of associated symptoms well-described in the literature. Medical complications were particularly common in elderly populations and many early publications described pneumonia, organ failure, acute respiratory distress syndrome, hypercoagulability/microthrombosis and superimposed bacterial/viral infections. There is, however, a lack of literature describing surgical complications of COVID-19 and as such little knowledge regarding safe surgical interventions. This case describes the presentation/management of a patient who developed COVID-19-associated necrotising pneumonia. Video-assisted thoracoscopy lobectomy was performed following CT demonstration of necrotising pneumonia. Pathological evaluation of the surgical resection specimen demonstrated the microarchitecture of a severely diseased COVID-19 lung-fibrosis. This case demonstrates the safe management of a necrotic lung using a minimal access approach in the context of COVID-19 infection.
Adamantinoma: metastatic disease masquerading as a gynaecological malignancy
Authors: Smyth Sarah , Addley Susan , Alazzam Moiad , Soleymani majd Hooman
Published: June 2021

Adamantinoma is a rare low-grade malignancy of the appendicular skeleton with unclear histogenesis. We present the case of a 65-year-old woman with known recurrent and metastatic right tibial disease despite clear resection margins. On further investigation, a positron emission tomography–CT scan identified a primary breast lesion and an 11 cm mass in the right iliac fossa of suspected ovarian malignancy amenable to surgical resection. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and resection of a retroperitoneal mass arising from the pelvic sidewall encompassing the iliac vasculature. The patient made an uneventful recovery with histology confirming disease metastasising to the pelvis. Currently, clinical management guidelines are not available. We present an overview of adamantinoma and highlight a previously undocumented gynaecological oncology surgical approach to this novel disease location. Regarding metastases, we acknowledge the challenges of investigation pertaining to disease site and origin as well as a paucity of recommendations for surveillance and follow-up.
Abdominal compartment syndrome secondary to chronic constipation in MECP2 duplication syndrome
Authors: Al Ali Alyaa , Singh Ram , Filler Guido , Ramsi Musaab
Published: June 2021

Abdominal compartment syndrome (ACS) is an infrequently encountered life-threatening disorder characterised by elevated abdominal pressure with evidence of new organ dysfunction. It is rarely reported in paediatrics. We describe an extremely unusual presentation of a 13-year-old boy with long-standing constipation who developed ACS complicated by refractory septic shock and multiorgan failure. He was treated with emergent decompressive laparotomy and supportive critical care. This case highlights the need for early diagnosis and timely management of ACS to improve its outcome.
Extrarenal rhabdoid tumour of the vulva: diagnostic and management challenges
Authors: Kumari Sarita , Natarajan Jayashree , Kumar Lalit , Bhatla Neerja
Published: June 2021

Extrarenal rhabdoid tumour (ERT) of vulva is a rare gynaecological neoplasm with an aggressive course and no clear management guidelines. We present the case of a 25-year-old woman with a rapidly increasing mass in right vulva suggestive of sarcoma. Wide local excision was done. Histopathology examination revealed ERT of vulva. Six weeks later she manifested lung metastases. Despite adjuvant chemotherapy, the disease progressed and she died 8 months later. We review the literature and briefly discuss the epidemiology, treatment approaches, prognostic factors and expected outcomes of this rare disease.
Platypnoea-orthodeoxia syndrome: the importance of the patient’s posture for diagnosis
Authors: Fontes Carla Pereira , Fonseca Samuel Barbosa , Santos Mário
Published: June 2021

Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by the association of dyspnoea and arterial oxygen desaturation induced by standing and relieved by recumbency. The precise mechanism remains poorly understood, but it appears to involve both anatomical and functional components producing a significant right-to-left shunting under certain postural conditions. This syndrome is associated with either intracardiac or extracardiac aetiologies, and the diagnosis depends on high clinical suspicion. Intracardiac shunt is the most common cause of POS and can be identified through echocardiography with bubble study. We report the case of a patient with POS secondary to a paradoxical shunt through the patent foramen oval, whose definitive diagnosis was only possible with contrasted transthoracic echocardiography in the sitting and standing positions.
Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19
Authors: Wander Pandora L , Lowy Elliott , Beste Lauren A , Tulloch-Palomino Luis , Korpak Anna , Peterson Alexander C , Young Bessie A , Boyko Edward J
Published: June 2021

Introduction

Risk factors and mediators of associations of diabetes with COVID-19 outcomes are unclear.

Research design and methods

We identified all veterans receiving Department of Veterans Affairs healthcare with ≥1 positive nasal swab for SARS-CoV-2 (28 February–31 July 2020; n=35 879). We assessed associations of diabetes (with and without insulin use) with hospitalization, intensive care unit (ICU) admission, or death at 30 days, and with hazard of death until the censoring date. Among participants with diabetes (n=13 863), we examined associations of hemoglobin A1c and antihyperglycemic medication use with COVID-19 outcomes. We estimated mediation between diabetes and outcomes by comorbidities (cardiovascular disease, heart failure, and chronic kidney disease), statin or ACE inhibitor/angiotensin receptor blocker (ARB) use, and cardiac biomarkers (brain natriuretic peptide and troponin).

Results

Diabetes with and without insulin use was associated with greater odds of hospitalization, ICU admission, and death at 30 days, and with greater hazard of death compared with no diabetes (OR 1.73, 1.76 and 1.63, and HR 1.61; and OR 1.39, 1.49 and 1.33, and HR 1.37, respectively, all p<0.0001). Prior sulfonylurea use was associated with greater odds of hospitalization and prior insulin use with hospitalization and death among patients with diabetes; among all participants, statin use was associated with lower mortality and ARB use with lower odds of hospitalization. Cardiovascular disease-related factors mediated <20% of associations between diabetes and outcomes.

Conclusions

Diabetes is independently associated with adverse outcomes from COVID-19. Associations are only partially mediated by common comorbidities.
Antibiotic use and colorectal neoplasia: a systematic review and meta-analysis
Authors: Aneke-Nash Chino , Yoon Garrett , Du Mengmeng , Liang Peter
Published: June 2021

Background and aims

Colorectal cancer (CRC) is the third most common cancer for women and men and the second leading cause of cancer death in the USA. There is emerging evidence that the gut microbiome plays a role in CRC development, and antibiotics are one of the most common exposures that can alter the gut microbiome. We performed a systematic review and meta-analysis to characterise the association between antibiotic use and colorectal neoplasia.

Methods

We searched PubMed, EMBASE, and Web of Science for articles that examined the association between antibiotic exposure and colorectal neoplasia (cancer or adenoma) through 15 December 2019. A total of 6031 citations were identified and 6 papers were included in the final analysis. We assessed the association between the level of antibiotic use (defined as number of courses or duration of therapy) and colorectal neoplasia using a random effects model.

Results

Six studies provided 16 estimates of the association between level of antibiotic use and colorectal neoplasia. Individuals with the highest levels of antibiotic exposure had a 10% higher risk of colorectal neoplasia than those with the lowest exposure (effect size: 1.10, 95% CI 1.01 to 1.18). We found evidence of high heterogeneity (I2=79%, p=0.0001) but not of publication bias.

Conclusions

Higher levels of antibiotic exposure is associated with an increased risk of colorectal neoplasia. Given the widespread use of antibiotics in childhood and early adulthood, additional research to further characterise this relationship is needed.
Low yield of head CT in cirrhotic patients presenting with hepatic encephalopathy
Authors: Hanna Angy , Gill Inayat , Imam Zaid , Halalau Alexandra , Jamil Laith H
Published: June 2021

Goals and background

The utility of routine head CT (HCT) in hepatic encephalopathy (HE) evaluation is unclear. We investigated HCT yield in detecting acute intracranial abnormalities in cirrhotic patients presenting with HE.

Study

Retrospective review of cirrhotic patient encounters with HE between 2016 and 2018 at Beaumont Health, in Michigan was performed. A low-risk (LR) indication for HCT was defined as altered mental status (AMS), which included dizziness and generalised weakness. A high-risk (HR) indication was defined as trauma/fall, syncope, focal neurological deficits (FNDs) or headache. Descriptive statistics and univariate/multivariate analyses by logistic regression were performed using SPSS to identify HCT abnormality correlates.

Results

Five hundred twenty unique encounters were reviewed. Mean age was 63.4 (12.1) years, 162 (37.5%) had alcoholic cirrhosis and median Model for End-Stage Liver Disease (MELD)-score was 17 (13–23). LR indication was reported in 408 (78.5%) patients and FNDs reported in 24 (4.6%) patients. Only 13 (2.5%) patients were found to have an acute intracranial pathology (seven haemorrhagic stroke, two ischaemic stroke, four subdural haematoma). Aspirin use prior to presentation (aOR 4.6, 95% CI 1.1 to 19.2), and HR indication (aOR 7.3, 95% CI 2.3 to 23.8) were independent correlates of acute intracranial pathology on HCT. Age, sex, MELD-score, haemoglobin, platelet count, race and cirrhosis aetiology did not correlate with HCT abnormalities. Number needed to screen to identify one acute pathology was 14 in HR indications versus 82 for LR indications.

Conclusion

Routine HCTs in cirrhotic patients presenting with HE with AMS in the absence of history of trauma, headache, syncope, FNDs or aspirin use is of low diagnostic yield.
Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative
Authors: Patel Leena N , Kozikott Samantha , Ilboudo Rodrigue , Kamateeka Moreen , Lamorde Mohammed , Subah Marion , Tsiouris Fatima , Vorndran Anna , Lee Christopher T
Published: June 2021

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.
Variation in waiting times by diagnostic category: an observational study of 1,951 referrals to a neurology outpatient clinic
Authors: Biggin Fran , Howcroft Timothy , Davies Quinta , Knight Jo , Emsley Hedley C A
Published: June 2021

Objective

To investigate the frequency of diagnoses seen among new referrals to neurology outpatient services; to understand how these services are used through exploratory analysis of diagnostic tests and follow-up appointments; and to examine the waiting times between referral and appointment.

Methods

Routine data from new National Health Service appointments at a single consultant-delivered clinic between September 2016 and January 2019 were collected. These clinical data were then linked to hospital administrative data. The combined data were assigned diagnostic categories based on working diagnoses to allow further analysis using descriptive statistics.

Results

Five diagnostic categories accounted for 62% of all patients seen within the study period, the most common of which was headache disorders. Following a first appointment, 50% of all patients were offered at least one diagnostic test, and 35% were offered a follow-up appointment, with variation in both measures by diagnostic category. Waiting times from referral to appointment also varied by diagnostic category. 65% of patients with a seizure/epilepsy disorder were seen within the 18-week referral to treatment target, compared with 38% of patients with a movement disorder.

Conclusions

A small number of diagnostic categories account for a large proportion of new patients. This information could be used in policy decision-making to describe a minimum subset of categories for diagnostic coding. We found significant differences in waiting times by diagnostic category, as well as tests ordered, and follow-up offered; further investigation could address causes of variation.
Cognitive development of children with Kawasaki disease and the parenting stress of their caregivers in Taiwan: a case–control study
Authors: Wang Liang-Jen , Tsai Zi-Yu , Chang Ling-Sai , Kuo Ho-Chang
Published: June 2021

Objective

Kawasaki disease (KD) is an acute form of febrile vasculitis that occurs in early childhood. The multisystemic vasculitis common in patients with KD may influence blood perfusion in the brain, and thus caregivers of children with KD may feel stress with regard to caring for them. Intravenous immunoglobulin (IVIG) infusion is the standard treatment for acute KD, and the most serious complication of KD is coronary artery aneurysms (coronary artery lesion (CAL)). This study aimed to investigate the relationships between KD heterogeneity and the risk of patients’ cognitive impairment or caregivers’ parenting stress.

Design

A case–control study with consecutive sampling.

Setting

A medical centre (Kaohsiung Chang Gung Memorial Hospital, Taiwan).

Participants

This study consisted of 176 patients with KD (mean age: 5.5 years, 60.8% boys) and 85 healthy children (mean age: 6.4 years, 54.1% boys).

Primary and secondary outcome measures

Based on the children’s age, each patient with KD and control subject was administered an assessment using the Mullen Scales of Early Learning or the Wechsler Intelligence Scale, and parenting function of their caregivers was assessed using the Parenting Stress Index (PSI)-Short Form.

Results

We observed no significant differences in any developmental index, cognitive function or parenting stress between patients with KD and controls. Among the children with KD, IVIG administration nor CAL was associated with children’s cognitive scores. However, the caregivers of patients who had CAL suffered from greater PSI total scores than those of patients without CAL. Furthermore, the caregivers who had education levels of a master’s degree or above showed less parenting stress than those who had an education level of college or lower.

Conclusion

Caregivers’ education is associated to parenting stress, and caregivers of patients with KD who developed CAL may feel stress about the unpredictable sequela caused by CAL for their children. Such caregivers may require support to fulfil their parenting roles.
Do women’s empowerment and socioeconomic status predict the adequacy of antenatal care? A cross-sectional study in five South Asian countries
Authors: Anik Asibul Islam , Islam Md Rashedul , Rahman Md Shafiur
Published: June 2021

Objectives

Relative to the attention given to improving the measurement of adequacy of antenatal care (ANC) in South Asian (SA) region, the influence of women’s empowerment and socioeconomic status (WESES) on adequate ANC services has hardly received any attention. This study aimed to investigate the present scenario of adequacy of ANC in SA and how its adequacy was associated with WESES.

Setting and participants

Using the Demographic and Health Survey data set of five SA countries, that is, Afghanistan, Bangladesh, India, Nepal and Pakistan, 48 107 women were selected in this study who received at least one ANC component and had at least one live birth in the 3 or 5 years preceding the survey.

Analysis

Multilevel logistic regression models were used to investigate the relationship between adequacy of ANC and WESES.

Results

Only 30% women received adequate ANC in SA, ranging from 8.4% (95% CI 7.1% to 9.9%) in Afghanistan to 39.8% (95% CI 37.4% to 42.2%) in Nepal. The poor utilisation of adequate ANC services was most prevalent among the women residing in rural areas and that of poor families as well as low empowerment status in SA countries. Different levels of WESES, that is, highly empowered but poor (adjusted OR (AOR): 1.33; 95% CI 1.18 to 1.49), lowly empowered but rich (AOR: 2.07; 95% CI 1.84 to 2.32) and highly empowered and rich women (AOR: 3.07; 95% CI 2.75 to 3.43), showed significant positive association with adequate ANC services than the poor and low empowered women, after adjusting the potential covariates.

Conclusion

As unsatisfactory level of adequate ANC services has been observed in SA region, this study suggests a nationwide comprehensive improvement of women’s empowerment status as well as establishment of necessary healthcare centres in remote areas is essential to ensure long-term and sustainable adequacy of ANC services.
Use of health-related quality-of-life measures for Indigenous child and youth populations: a scoping review protocol
Authors: McCarty Georgia , Derrett Sarah , Sullivan Trudy , Crengle Sue , Wyeth Emma
Published: June 2021

Introduction

Measures of health-related quality-of-life (HRQoL) are increasingly important for evaluating healthcare interventions and treatments, understanding the burden of disease, identifying health inequities, allocating health resources and for use in epidemiological studies. Although many HRQoL measures developed for use in adult populations are robust, they are not necessarily designed, or appropriate, to measure HRQoL for children/youth. Furthermore, the appropriateness of HRQoL measures for use with Indigenous child/youth populations has not been closely examined. The aims of this scoping review are to (1) identify and describe empirical studies using HRQoL measures among children/youth (aged 8–17 years) from Indigenous populations within the Pacific Rim, (2) summarise the study designs and modes of HRQoL measure administration, (3) describe the key dimensions of the identified HRQoL measures used among Indigenous populations, including specifically among Māori and (4) map the HRQoL measure dimensions to commonly used Māori models of health.

Methods and analysis

The scoping review framework developed by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines will be followed for best practice and reporting. An iterative search of peer-reviewed published empirical research reporting the use of child/youth HRQoL measures among Indigenous populations will be conducted. This literature will be identified across the following five databases: Ovid (Medline), PubMed, Scopus, Web of Science and CINHAL. The search will be restricted to papers published in English between January 1990 and June 2020. Two reviewers will independently review the papers in two stages. A third reviewer will resolve any discrepancies that arise. A data charting form will be completed using data extracted from each paper.

Ethics and dissemination

Ethical approval was not required for this scoping review. Dissemination will include publication of the scoping review in a peer-reviewed journal. This scoping review will inform a larger research project (HRC 20/166).
Exploring high mortality rates among people with multiple and complex needs: a qualitative study using peer research methods
Authors: Perry Rachel , Adams Emma A. , Harland Jill , Broadbridge Angela , Giles Emma L. , McGeechan Grant J. , O'Donnell Amy , Ramsay Sheena E.
Published: June 2021

Objective

To explore the perceived reasons underlying high mortality rates among people with multiple and complex needs.

Design

Qualitative study using peer research.

Setting

North East of England.

Participants

Three focus group discussions were held involving (1) people with lived experience of multiple and complex needs (n=5); (2) front-line staff from health, social care and voluntary organisations that support multiple and complex needs groups (n=7); and (3) managers and commissioners of these organisations (n=9).

Results

Findings from this study provide valuable perspectives of people with multiple complex needs and those that provide them with support on what may be perceived factors underlying premature mortality. Mental ill health and substance misuse (often co-occurring dual diagnosis) were perceived as influencing premature mortality among multiple and complex needs groups. Perceptions of opportunities to identify people at risk included critical life events (eg, bereavement, relationship breakdown) and transitions (eg, release from prison, completion of drug treatment). Early prevention, particularly supporting young people experiencing adverse childhood experiences, was also highlighted as a priority.

Conclusion

High mortality in multiple and complex needs groups may be reduced by addressing dual diagnosis, providing more support at critical life events and investing in early prevention efforts. Future interventions could take into consideration the intricate nature of multiple and complex needs and improve service access and navigation.