bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter closure for patent ductus arteriosus in patients with Eisenmenger syndrome: to do or not?
Authors: Xu Jing , Wang Liang , Shen Yunli , Geng Liang , Chen Fadong
Published: December 2020

Background

Patent ductus arteriosus (PDA) complicated by Eisenmenger syndrome (ES) remains to be a major cause of morbidity and mortality worldwide. Giving increasing evidences of benefit from targeted therapies, ES patients once thought to be inoperable may have increasing options for management. This study aims to explore whether PDA in patients with ES can be treated with transcatheter closure (TCC).

Methods

Between August 2014 and July 2016, four of fifteen PDA-ES patients whose Qp/Qs improved significantly and Qp/Qs > 1.5 after acute vasodilator testing with 100% oxygen were selected to receive TCC and pulmonary vasodilator therapy. PAH-targeted drugs were prescribed before and after occlusion for all. Trial occlusion was performed before permanent closure.

Results

The first TCC failed after initiation of PAH-targeted drugs for 6 months in four patients. After the medication was adjusted and extended to 12 months, TCC was performed for all without hemodynamic intolerances during perioperative period. Pulmonary artery systolic pressure (PASP) was significantly decreased (≥ 40%) immediately after TCC. During a mean follow-up of 48 ± 14.70 months, there were a further decrease of PASPs in two patients, the other two showed improved pulmonary vascular resistance, WHO functional class and six-minute walking distance despite deteriorated PASP.

Conclusion

Some selected PDA-ES patients might benefit from TCC and combined PAH-targeted drugs play a crucial role.
The diagnostic capability of electrocardiography on the cardiogenic shock in the patients with acute myocarditis
Authors: Yang Dan , Dai Qing , Wu Han , Chen Jianzhou , Zhang Jingmei , Wei Zhonghai
Published: December 2020

Background

The study was performed to assess the diagnostic capability of ECG on the cardiogenic shock (CS) in acute myocarditis. A new score was derived from the combination of the ECG parameters and the diagnostic value was also evaluated.

Methods

Total 103 consecutive patients with acute myocarditis admitted in Nanjing Drum Hospital were enrolled in the current study. The cohort was divided into fulminant myocarditis group (FM, n = 20) and non fulminant myocarditis group (NFM, n = 83). The demographic features, results of electrocardiography (ECG) and ultracardiography were compared. Logistic regression analysis was conducted to identify the relevant factors in ECG parameters. We created a new variable called “ECG score” by certain combination of ECG parameters. The diagnostic capability of ECG score for CS was compared with the existing diagnostic indices using regression model and receiver-operating characteristics (ROC) analysis.

Results

There were several changes on ECG significantly different between the two groups. Multivariate regression analysis demonstrated PR + QRS interval (P = 0.008), ventricular arrhythmia (P = 0.001) and pathological Q wave (P = 0.003) were the independent relevant factors of CS. The derived variable “ECG score” was identified as a significant relevant factor of CS by multivariate regression model. ROC analysis showed PR + QRS interval, ventricular arrhythmia and pathological Q wave all had equivalent diagnostic capability to left ventricular ejection fraction (LVEF) and shock index (SI). ECG score was equivalent to LVEF but superior to SI in diagnosing CS

Conclusions

ECG was valuable in diagnosing CS due to acute myocarditis. The ECG score was superior to the traditional diagnostic indices and could be used for an rapid recognition of CS.
Diversity in substance use behaviour among street children of Delhi under Bayesian paradigm
Authors: Verma Vivek , Mishra Ashwani Kumar , Dhawan Anju , Nath Dilip C.
Published: December 2020

Background

Shannon’s index is one of the measures of biodiversity, which is intended to quantify both richness and evenness of the species/individuals in the ecosystem or community. However, application of Shannon’s index in the field of substance use among the street children has not been done till date.

Methods

This paper is concerned with methods of estimating Shannon’s diversity index (SDI), which can be used to capture the variation in the population due to certain characteristics. Under the consideration that the probability of abundance, based on certain characteristics in the population, is a random phenomenon, we derive a Bayesian estimate in connection with Shannon’s information measure and their properties (mean and variance), by using a probability matching prior, through simulation and compared it with those of the classical estimates of Shannon. The theoretical framework has been applied to the primary survey data of substance use among the street children in Delhi, collected during 2015. The measure of diversity was estimated across different age profiles and districts.

Results

The results unrevealing the diversity estimate for street children corresponding to each region of Delhi, under both the classical and Bayesian paradigms. Although the estimates were close to one another, a striking difference was noted in the age profile of children.

Conclusions

The Bayesian methodology provided evidence for a greater likelihood of finding substance-using street children, belonging to the lower age group (7-10, maximum Bayesian entropy-3.73), followed by the middle (11-14) and upper age group (15-18). Moreover, the estimated variance under the Bayesian paradigm was lesser than that of the classical estimate. There is ample scope for further refinement in these estimates, by considering more covariates that may have a possible role in initiating substance use among street children in developing countries like India.
Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study
Authors: Fan Ning , Hu Yong , Shen Hong , Liu Shengjie , Zhao Guang , Sun Lanju , Li Chunyan , Zhao Xin , Li Yanning , Wang Jianhua , Cui Yunfeng
Published: December 2020

Background

Infection is one of the important causes of death in patients with severe acute pancreatitis (SAP), but the bacterial spectrum and antibiotic resistance are constantly changing. Making good use of antibiotics and controlling multi-drug-resistant (MDR) bacterial infections are of vital importance in improving the cure rate of SAP. We conducted a retrospective study in the hope of providing references for antibiotic selection and control of drug-resistant bacteria.

Methods

Retrospective analysis was performed on the data of patients hospitalized in our hospital due to acute pancreatitis (AP) in the past 5 years. General data were classified and statistically analyzed. Subsequently, the bacterial spectrum characteristics and the data related to drug-resistant bacterial infection of 569 AP patients were analyzed. Finally, unconditional logistic regression analysis was conducted to analyze the risk factors of MDR infection.

Results

A total of 398 patients were enrolled in this study and the hospitalization data and associated results were analyzed. A total of 461 strains of pathogenic bacteria were detected, including 223 (48.4%) gram-negative bacterial strains, 190 (41.2%) gram-positive bacterial strains and 48 (10.4%) fungal strains. The detection rates of resistance in gram-negative and gram-positive bacterial strains were 48.0% (107/223) and 25.3% (48/190), respectively. There were significant differences between the MDR group and the non-MDR group for the factors of precautionary antibiotic use, kinds of antibiotics used, receipt of carbapenem, tracheal intubation, hemofiltration and number of hospitalization days in the intensive care unit. Unconditional logistic regression revealed 2 risk factors for MDR bacterial infection.

Conclusions

Our results illustrate that gram-negative bacteria were the most common pathogens in SAP infection, and the proportion of gram-positive bacteria increased notably. The rate of antibiotic resistance was higher than previously reported. Unconditional logistic regression analysis showed that using more types of antibiotics and the number of hospitalization days in the ICU were the risk factors associated with MDR bacterial infection.
Anthropometric indicators as a discriminator of sarcopenia in community-dwelling older adults of the Amazon region: a cross-sectional study
Authors: Esteves Cássio Lima , Ohara Daniela Gonçalves , Matos Areolino Pena , Ferreira Vânia T. K. , Iosimuta Natalia C. R. , Pegorari Maycon Sousa
Published: December 2020

Background

Sarcopenia is a geriatric syndrome associated with negative health outcomes and the use of viable alternative screening tools may help in the diagnosis of this condition. This study aimed to analyze the association of sarcopenia with anthropometric indicators among community-dwelling older adults and to identify cut-off points for such indicators as a discriminant criterion for predicting sarcopenia.

Methods

This was a cross-sectional study conducted on community-dwelling older adults ≥60 years old (n = 411) of both sexes from Macapá, Amapá, Brazil. Socioeconomic, clinical and anthropometric data (arm circumference - AC, waist circumference - WC, calf circumference - CC and body mass index – BMI) were collected using a structured form. Sarcopenia was identified according to the EWGSOP 2 consensus. The association between anthropometric indicators and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve. Statistical significance was defined as p ≤ 0.05.

Results

Adjusted analysis indicated an independent and inverse association between sarcopenia and the anthropometric indicators: AC (odds ratio, OR: 0.63; 95% confidence interval, 95%CI: 0.53–0.76), CC (OR: 0.73; 95%CI: 0.62–0.85), WC (OR: 0.93; 95%CI: 0.90–0.97) and BMI (OR: 0.64; 95%CI: 0.53–0.76). The following cut-off points for older men and women represented the discriminant criterion for the presence of sarcopenia: WC (≤97 and ≤ 86 cm), CC (≤33 and ≤ 31 cm), AC (≤27 cm) and BMI (≤24.8 kg/m2 and ≤ 24.5 kg/m2) (area under the ROC curve superior to 0.70). BMI and AC were the indicators with the highest ability to discriminate older adults of both sexes with sarcopenia.

Conclusions

An increase of one unit of the indicators can reduce the probability of occurrence of sarcopenia. All indicators were considered to discriminate the occurrence of sarcopenia, with emphasis on BMI and AC, and could be used to screen for this condition among community-dwelling older adults.
Specific dynamic variations in the peripheral blood lymphocyte subsets in COVID-19 and severe influenza A patients: a retrospective observational study
Authors: Qian Fang , Gao Guiju , Song Yangzi , Xu Yanli , Wang Aibin , Wang Sa , Hao Yiwei , Chen Meiling , Ma Xiaoyang , Zhao Tianwei , Guo Xiaodi , Chen Zhihai , Zhang Fujie
Published: December 2020

Background

Both COVID-19 and influenza A contribute to increased mortality among the elderly and those with existing comorbidities. Changes in the underlying immune mechanisms determine patient prognosis. This study aimed to analyze the role of lymphocyte subsets in the immunopathogenesisof COVID-19 and severe influenza A, and examined the clinical significance of their alterations in the prognosis and recovery duration.

Methods

By retrospectively reviewing of patients in four groups (healthy controls, severe influenza A, non-severe COVID-19 and severe COVID-19) who were admitted to Ditan hospital between 2018 to 2020, we performed flow cytometric analysis and compared the absolute counts of leukocytes, lymphocytes, and lymphocyte subsets of the patients at different time points (weeks 1–4).

Results

We reviewed the patients’ data of 94 healthy blood donors, 80 Non-severe-COVID-19, 19 Severe-COVID-19 and 37 severe influenza A. We found total lymphocytes (0.81 × 109/L vs 1.74 × 109/L, P = 0.001; 0.87 × 109/L vs 1.74 × 109/L, P < 0.0001, respectively) and lymphocyte subsets (T cells, CD4+ and CD8+ T cell subsets) of severe COVID-19 and severe influenza A patients to be significantly lower than those of healthy donors at early infection stages. Further, significant dynamic variations were observed at different time points (weeks 1–4).

Conclusions

Our study suggests the plausible role of lymphocyte subsets in disease progression, which in turn affects prognosis and recovery duration in patients with severe COVID-19 and influenza A.
An outbreak of gastroenteritis associated with a novel GII.8 sapovirus variant-transmitted by vomit in Shenzhen, China, 2019
Authors: Yan Yuxiao , Li Yuan , Shi Wen , Kong Xiangyu , Li Huiying , Zhang Qing , Pang Lili , Jiang Li , Liu Junying , Jin Miao , Li Yuning , Duan Zhaojun
Published: December 2020

Background

Human Sapoviruses (SaVs) has been reported as one of the causative agents of acute gastroenteritis (AGE) worldwide. An outbreak of SaVs affected 482 primary school students during spring activities from February 24 to March 11, 2019 in Shenzhen City, China. Our study was aimed at determining the epidemiology of the outbreak, investigating its origins, and making a clear identification of the SaVs genetic diversity.

Methods

Epidemiological investigation was conducted for this AGE outbreak. Stool samples were collected for laboratory tests of causative agents. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) and conventional RT-PCR were used for detecting and genotyping of SaVs. The nearly complete genome of GII.8 SaV strains were amplified and sequenced by using several primer sets designed in this study. Phylogenetic analysis was performed to characterize the genome of GII.8 SaV strains.

Results

The single factor analysis showed that the students who were less than 1.5 m away from the vomitus in classroom or playgroundwere susceptible (P < 0.05). Seven of 11 fecal samples from patients were positive for GII.8 SaV genotype. In this study, we obtained the genome sequence of a SaV GII.8 strain Hu/SaV/2019008Shenzhen/2019 /CHN (SZ08) and comprehensively analyzed the genetic diversity. The phylogenetic analysis showed that the GII.8 strain SZ08 formed an independent branch and became a novel variant of GII.8 genotype. Strain SZ08 harbored 11 specific amino acid variations compared with cluster A-D in full-length VP1.

Conclusions

This study identified SaVs as the causative agents for the AGE outbreak. Strain Hu SZ08 was clustered as independent branch and there was no recombination occurred in this strain SZ08. Further, it might become the predominant strain in diarrhea cases in the near future. Constant surveillance is required to monitor the emerging variants which will improve our knowledge of the evolution of SaVs among humans.
The clinical characteristics and outcome of cryptococcal meningitis with AIDS in a tertiary hospital in China: an observational cohort study
Authors: Wu Liang , Xiao Jiang , Song Yangzi , Gao Guiju , Zhao Hongxin
Published: December 2020

Background

Despite the profound impact of antiretroviral therapy in the control of AIDS mortality, central nervous system opportunistic infections remains a significant burden in AIDS patients. This retrospective study aims to elucidate the clinical characteristics, outcome and risk factors of cryptococcal meningitis (CM) poor prognosis in AIDS patients from a tertiary hospital in China.

Methods

Clinical data from 128 patients admitted in Beijing Ditan Hospital, Capital Medical University from November 2008 to November 2017 was collected. The cohort was stratified based on treatment outcome (effective 79%, and ineffective 21%), and Multivariate Logistic regression analysis used to identify risk factors of poor disease prognosis.

Results

Age, incidence of cerebral infarction, the proportion of consciousness disorder, and fasting plasma glucose was higher in the ineffective treatment group than the effective treatment group. The duration of treatment in the induction period of the ineffective group was significantly shorter than that of the effective group. Multivariate Logistic regression analysis indicated that the occurrence of cerebral hernia and consciousness disorder were risk factors for the prognosis of AIDS patients with CM infection, while the duration of treatment in the induction period was a indicative of a better prognosis in AIDS with CM infection complications. Finally, shunt decompression therapy correlated with a better disease outcome.

Conclusions

This retrospective study exposes the main risk factors associated with worse disease prognosis in AIDS patients with CM infection complications.
Prevalence, phylogeny, and antimicrobial resistance of Escherichia coli pathotypes isolated from children less than 5 years old with community acquired- diarrhea in Upper Egypt
Authors: Khairy Rasha M. M. , Fathy Zahra Atef , Mahrous Doaa Mohamed , Mohamed Ebtisam S. , Abdelrahim Soha S.
Published: December 2020

Background

Diarrhoea, affecting children in developing countries, is mainly caused by diarrheagenicEscherichia coli(DEC). This study principally aimed to determine the prevalence of DEC pathotypes and Extended-spectrum β-lactamase (ESBL) genes isolated from children under 5 years old with diarrhea.

Methods

A total of 320 diarrhoea stool samples were investigated.E. coliisolates were investigated for genes specific for enterotoxigenicE. coli(ETEC), enteropathogenicE. coli(EPEC), enteroaggregativeE. coli(EAEC), enteroinvasiveE. coli(EIEC) and enterohemorrhagicE. coli(EHEC) using polymerase chain reaction (PCR). Furthermore, antimicrobial susceptibility testing, detection of antibiotic resistance-genes and phylogenetic typing were performed.

Results

Over all, DEC were isolated from 66/320 (20.6%) of the children with diarrhoea. EAEC was the predominant (47%), followed by typical EPEC (28.8%) and atypical EPEC (16.6%). Co-infection by EPEC and EAEC was detected in (7.6%) of isolates. However, ETEC, EIEC and EHEC were not detected. Phylogroup A (47%) and B2 (43.9%) were the predominant types. Multidrug-resistance (MDR) was found in 55% of DEC isolates. Extended-spectrumβ-lactamase (ESBL) genes were detected in 24 isolates (24blaTEMand 15blaCTX-M-15). Only one isolate harbored AmpCβ-lactamase gene (DHA gene).

Conclusion

The study concluded that, EAEC and EPEC are important causative agents of diarrhoea in children under 5 years. MDR among DEC has the potential to be a big concern.
Clinical characteristics and outcomes of influenza A and B virus infection in adult Australian hospitalised patients
Authors: Sharma Yogesh , Horwood Chris , Hakendorf Paul , Thompson Campbell
Published: December 2020

Background

Influenza B is often perceived as a less severe strain of influenza. The epidemiology and clinical outcomes of influenza B have been less thoroughly investigated in hospitalised patients. The aims of this study were to describe clinical differences and outcomes between influenza A and B patients admitted over a period of 4 years.

Methods

We retrospectively collected data of all laboratory confirmed influenza patients ≥18 years at two tertiary hospitals in South Australia. Patients were confirmed as influenza positive if they had a positive polymerase-chain-reaction (PCR) test of a respiratory specimen. Complications during hospitalisation along with inpatient mortality were compared between influenza A and B. In addition, 30 day mortality and readmissions were compared. Logistic regression model compared outcomes after adjustment for age, Charlson index, sex and creatinine levels.

Results

Between January 2016–March 2020, 1846 patients, mean age 66.5 years, were hospitalised for influenza. Of whom, 1630 (88.3%) had influenza A and 216 (11.7%) influenza B. Influenza B patients were significantly younger than influenza A. Influenza A patients were more likely be smokers with a history of chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) than influenza B. Complications, including pneumonia and acute coronary syndrome (ACS) were similar between two groups, however, septic shock was more common in patients with influenza B. Adjusted analyses showed similar median length of hospital stay (LOS), in hospital mortality, 30-day mortality and readmissions between the two groups.

Conclusions

Influenza B is less prevalent and occurs mostly in younger hospitalised patients than influenza A. Both strains contribute equally to hospitalisation burden and complications.

Trial registration

Australia and New Zealand Clinical Trial Registry (ANZCR) no ACTRN12618000451202 date of registration 28/03/2018
Immunoproteomics approach revealed elevated autoantibody levels against ANXA1 in early stage gallbladder carcinoma
Authors: Akhtar Javed , Priya Ratna , Jain Vaishali , Sakhuja Puja , Agarwal Anil Kumar , Goyal Surbhi , Polisetty Ravindra Varma , Sirdeshmukh Ravi , Kar Sudeshna , Gautam Poonam
Published: December 2020

Background

Early diagnosis is important for the timely treatment of gallbladder carcinoma (GBC) patients and may lead to increased survival outcomes. Here, we have applied serological proteome analysis (SERPA), an immunoproteomics approach, for the detection of ‘tumor-associated antigens (TAAs) that elicit humoral response’ in early stage GBC patients.

Methods

Total protein from pooled tumor tissue of GBC patients (n = 7) was resolved by two-dimensional gel electrophoresis (2-DE) followed by immunoblotting using pooled blood plasma from healthy volunteers (n = 11) or gallstone disease (GSD) cases (n = 11) or early stage GBC (Stage I and II) (n = 5) or GBC stage IIIA (n = 9). 2-D gel and immunoblot images were acquired and analyzed using PDQuest software to identify immunoreactive spots in GBC cases in comparison to controls. Proteins from immunoreactive spots were identified by liquid chromatography- tandem mass spectrometric analysis (LC-MS/MS). Autoantibody levels for two of the functionally relevant proteins were investigated in individual plasma samples (52 cases and 89 controls) by dot blot assay using recombinant proteins.

Results

Image analysis using PDQuest software identified 25 protein spots with significantly high or specific immunoreactivity in GBC cases. Mass spectrometric analysis of 8 corresponding protein spots showing intense immunoreactivity (based on densitometric analysis) in early stage GBC or GBC stage IIIA cases led to the identification of 27 proteins. Some of the identified proteins include ANXA1, HSPD1, CA1, CA2, ALDOA and CTSD. Among the two proteins, namely ANXA1 and HSPD1 verified using a cohort of samples, significantly elevated autoantibody levels against ANXA1 were observed in early stage GBC cases in comparison to healthy volunteers or GSD cases (unpaired t-test, p < 0.05). Receiver operating characteristic (ROC) curve analysis for ANXA1 showed an Area under the Curve (AUC) of 0.69, with 41.7% sensitivity against a specificity of 89.9% for early stage GBC. IHC analysis for ANXA1 protein showed ‘high’ expression levels in 72% of GBC cases whereas all the controls showed ‘low’ expression levels.

Conclusions

The study suggests that the ANXA1 autoantibody levels against ANXA1 may be potentially employed for early stage detection of GBC patients. Other proteins could also be explored and verified in a large cohort of clinical samples.
Belatacept associated - cytomegalovirus retinitis in a kidney transplant recipient: a case report and review of the literature
Authors: Deliège Pierre-Guillaume , Bastien Justine , Mokri Laetitia , Guyot-Colosio Charlotte , Arndt Carl , Rieu Philippe
Published: December 2020

Background

To report the first case of belatacept-associated multidrug-resistant Cytomegalovirus retinitis in a kidney transplant recipient.

Case presentation

A 76-year-old African male renal allograft recipient was admitted for acute visual loss of the right eye. Ophthalmological examination of the right eye showed anterior uveitis and vitritis associated with large paravascular haemorrhages and yellow necrotic borders, involving the posterior pole but not the fovea. Both Cytomegalovirus DNA in plasma and aqueous humor were positive. The patient had had several episodes of Cytomegalovirus reactivation subsequent to the introduction of belatacept. His cytomegalovirus was multi-drug resistant, and was treated with maribarir, intravitreal and systemic injections of foscarnet, and anti-Cytomegalovirus human immunoglobulin. In parallel, belatacept was stopped and switched to tacrolimus. Cytomegalovirus DNA became undetectable and there was partial improvement of visual acuity at the last ophthalmologic examination, 18 months after the initial diagnosis of Cytomegalovirus retinitis.

Conclusion

Cytomegalovirus retinitis is an uncommon opportunistic infection in kidney transplant recipients. Cytomegalovirus retinitis is a serious infection because of the risk of blindness and the occurrence of associated life-threatening opportunistic infections. In view of the recent literature, kidney transplant recipients treated by belatacept immunosuppression may be at increased risk for Cytomegalovirus disease, notably Cytomegalovirus retinitis. The occurrence of Cytomegalovirus retinitis may help improve the selection of patients converted to belatacept.
The impact of social insurance on health among middle-aged and older adults in rural China: a longitudinal study using a three-wave nationwide survey
Authors: Ma Xinxin , Oshio Takashi
Published: December 2020

Background

Many studies have examined the impact of social insurance on health, but the results have generally been mixed, presumably because they have not fully addressed potential biases related to the study’s cross-sectional design. In this study, we conducted a longitudinal analysis to investigate how participation in two social insurance programs in China—the New Rural Social Pension Insurance (NRSPI) and the New Rural Cooperative Medical Scheme (NRCMS)—was associated with health outcomes among middle-aged and older adults in rural China.

Methods

Using three-wave longitudinal data from the China Health and Retirement Longitudinal Study conducted in 2011, 2013, and 2015, we estimated the dynamic fixed-effects regression models to examine the association between participation in the NRCMS/NRSPI and six types of health outcomes.

Results

Participation in the NRSPI was positively associated with some health outcomes, but the associations were relatively modest and were observed only for some specific age and household income groups. Participation in NRCMS was not associated with any health outcomes.

Conclusions

The results provide limited evidence of the positive impact of social insurance on health among middle-aged and older adults in rural China. Thus, social insurance programs should be reformed to enhance their positive impact on health.
The prevalence of hypertension and its distribution by sociodemographic factors in Central Mozambique: a cross sectional study
Authors:   the InCoMaS Study Team, Matsuzaki Mika , Sherr Kenneth , Augusto Orvalho , Kawakatsu Yoshito , Ásbjörnsdóttir Kristjana , Chale Falume , Covele Alfredo , Manaca Nelia , Muanido Alberto , Wagenaar Bradley H. , Mocumbi Ana O. , Gimbel Sarah
Published: December 2020

Background

Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevalence has been rising in low- and middle-income countries. The current study describes HTN prevalence in central Mozambique, association between wealth and blood pressure (BP), and HTN monitoring and diagnosis practice among individuals with elevated BP.

Methods

The study used data from a cross-sectional, representative household survey conducted in Manica and Sofala provinces, Mozambique. There were 4101 respondents, aged ≥20 years. We measured average systolic and diastolic BP (SBP and DBP) from three measurements taken in the household setting. Elevated BP was defined as having either SBP ≥140 or DBP ≥90 mmHg.

Results

The mean age of the participants was 36.7 years old, 59.9% were women, and 72.5% were from rural areas. Adjusting for complex survey weights, 15.7% (95%CI: 14.0 to 17.4) of women and 16.1% (13.9 to 18.5) of men had elevated BP, and 7.5% (95% CI: 6.4 to 8.7) of the overall population had both SBP ≥140 and DBP ≥90 mmHg. Among participants with elevated BP, proportions of participants who had previous BP measurement and HTN diagnosis were both low (34.9% (95% CI: 30.0 to 40.1) and 12.2% (9.9 to 15.0) respectively). Prior BP measurement and HTN diagnosis were more commonly reported among hypertensive participants with secondary or higher education, from urban areas, and with highest relative wealth. In adjusted models, wealth was positively associated with higher SBP and DBP.

Conclusions

The current study found evidence of positive association between wealth and BP. The prevalence of elevated BP was lower in Manica and Sofala provinces than the previously estimated national prevalence. Previous BP screening and HTN diagnosis were uncommon in our study population, especially among rural residents, individuals with lower education levels, and those with relatively less wealth. As the epidemiological transition advances in Mozambique, there is a need to develop and implement strategies to increase BP screening and deliver appropriate clinical services, as well as to encourage lifestyle changes among people at risk of developing hypertension in near future.
Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study
Authors: Aydogan Emrah , Langer Stefan , Josten Christoph , Fakler Johannes Karl Maria , Henkelmann Ralf
Published: December 2020

Background

Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.

Methods

We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.

Results

We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year.

Conclusions

Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.
Prevalence and predictors of work-related musculoskeletal disorders among workers of a gold mine in south Kivu, Democratic Republic of Congo
Authors: Okello Alfred , Wafula Solomon Tsebeni , Sekimpi Deogratias K. , Mugambe Richard K.
Published: December 2020

Background

Work-related musculoskeletal disorders (WRMSDs) are a major constraint to worker performance and health. However, research on their prevalence and associated factors among workers at gold mines in the Democratic Republic of Congo (DRC) is insufficient. The present study aimed to determine the prevalence and predictors of WRMSDs among workers of a Gold Mine in South Kivu, DRC.

Methods

Cross sectional data on prevalence of WRMSDs and risk factors was collected using a modified Nordic questionnaire and upper limb Core QX checklist from 196 workers of a gold mine. WRMSDs were defined as pain or injury(ies) or discomfort, numbness or limitation of movement in the musculoskeletal system at any time in the past 12 months which lasted at least 24 h. These had to be either induced or aggravated by work and circumstances of its performance. A generalised linear model of the Poison family with link log and robust error variances was used to generate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the factors associated with WRMSDs. The effect of individual, ergonomic and psychosocial factors on WRMSDs were investigated while controlling for known confounders.

Results

Most workers were males 187 (95.4%) and their age ranged between 23 and 60 years with mean of 36.3 years. Of the 196 workers, 49 (25.0%) reported having at least one WRMSD during the previous 12 months. WRMSDs with highest occurrence rate were the lower back pain (14.8%), followed by thighs/hip pain (9.2%) and shoulder pain (8.2%). Prolonged heavy lifting/shovelling shovelling (PR = 1.69, 95% CI [1.32, 3.24] and longer work shifts (> 9 h) (PR = 3.56, 95% CI [1.76, 16.58]) were predictive for WRMSDs while jobs with low demands were protective against WRMSDs (PR = 0.18, 95% CI [0.08, 0.44]).

Conclusion

The prevalence of WRMSDs is high and associated with prolonged heavy lifting/shovelling, longer work shifts and job demands. We recommend lowering workload and job demands and improving work ergonomics to mitigate and prevent the WRMSDs among workers in goldmines.
ICF-based multidisciplinary rehabilitation program for complex regional pain syndrome of the hand: efficacy, long-term outcomes, and impact of therapy duration
Authors: Kotsougiani-Fischer D. , Choi J. S. , Oh-Fischer J. S. , Diehm Y. F. , Haug V. F. , Harhaus L. , Gazyakan E. , Hirche C. , Kneser U. , Fischer S.
Published: December 2020

Background

Complex regional pain syndrome (CRPS) is a rare but feared complication in hand surgery. Although multimodal therapy concepts are recommended, there is only low evidence on efficacy of such approaches. Furthermore, recommendations regarding therapy duration are lacking. Aim of this study was to validate the efficacy of an International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation concept for treatment of CRPS of the hand and to find correlations between therapy duration and outcome measures.

Methods

Patients with CRPS of the hand after occupational trauma that underwent an ICF-based rehabilitation program between 2010 and 2014 were included in this retrospective study. Besides demographic data, outcomes included pain (VAS), range of motion assessed by fingertip-to-palm-distance (PTPD) and fingernail-to-table-distance (FTTD) as well as strength in grip, 3-point pinch and lateral pinch. All measures were gathered at admission to and discharge from inpatient rehabilitation therapy as well as at follow-up. Statistical analysis included paired t-test, ANOVA and Pearson's correlation analysis.

Results

Eighty-nine patients with a mean age of 45 years were included in this study. Duration of rehabilitation therapy was 53 days on average. All outcomes improved significantly during rehabilitation therapy. Pain decreased from 6.4 to 2.2. PTPD of digit 2 to 5 improved from 2.5, 2.8, 2.6, and 2.3 cm to 1.3, 1.4, 1.2, and 1.1 cm, respectively. FTTD of digit 2 to 5 decreased from 1.5, 1.7, 1.5, and 1.6 cm to 0.6, 0.8, 0.7, and 0.7 cm, respectively. Strength ameliorated from 9.5, 3.7, 2.7 kg to 17.9, 5.6, 5.0 kg in grip, lateral pinch, and 3-point pinch, respectively. Improvement in range of motion significantly correlated with therapy duration. 54% of patients participated at follow-up after a mean of 7.5 months. Outcome measures at follow-up remained stable compared to discharge values without significant differences.

Conclusion

The ICF-based rehabilitation concept is a reliable and durable treatment option for CRPS of the hand. Range of motion improved continuously with therapy duration and thus may serve as an indicator for optimum length of therapy.
Reconstitution of Drosophila and human chromatins by wheat germ cell-free co-expression system
Authors: Okimune Kei-ichi , Nagy Szilvia K. , Hataya Shogo , Endo Yaeta , Takasuka Taichi E.
Published: December 2020

Background

Elaboration of the epigenetic regulation of chromatin is a long-standing aim in molecular and cellular biology. Hence, there is a great demand for the development of in vitro methods to reconstitute chromatin that can be used directly for biochemical assays. The widely used wheat germ cell-free protein expression method provides broad applications to investigate the function and structure of eukaryotic proteins. Such advantages, including high translation efficiency, flexibility, and possible automatization, are beneficial for achieving native-like chromatin substrates for in vitro studies.

Results

We describe a novel, single-step in vitro chromatin assembly method by using the wheat germ cell-free protein synthesis. We demonstrated that both Drosophila and human chromatins can be reconstituted in the course of the in vitro translation of core histones by the addition of chromatin assembly factors, circular plasmid, and topoisomerase I in an ATP-dependent manner. Drosophila chromatin assembly was performed in 4 h at 26 °C, in the presence of premixed mRNAs encoding the core histones, dAcf1/dISWI chromatin remodeling complex, and nucleosome assembly protein, dNAP1. Similarly, the human chromatin was assembled by co-expressing the human core histones with Drosophila chromatin remodeling factor, dISWI, and chromatin chaperone, dNLP, for 6 h at 26 °C. The presence of reconstituted chromatin was monitored by DNA supercoiling assay, also the regular spacing of nucleosomes was assessed by Micrococcal nuclease assay. Furthermore, Drosophila linker histone H1-containing chromatin was reconstituted, affirming that the in vitro assembled chromatin is suitable for downstream applications.

Conclusions

The method described in this study allows the assembly of Drosophila and human chromatins, possibly in native-like form, by using a wheat germ cell-free protein expression. Although both chromatins were reconstituted successfully, there were unexpected differences with respect to the required ratio of histone-coding mRNAs and the reaction time. Overall, our new in vitro chromatin reconstitution method will aid to characterize the unrevealed structure, function, and regulation of chromatin dynamics.
Interkingdom interaction between C. albicans and S. salivarius on titanium surfaces
Authors: Martorano-Fernandes Loyse , Rodrigues Nadiny Cezar , de Souza Borges Maria Heloísa , Cavalcanti Yuri Wanderley , de Almeida Leopoldina de Fátima Dantas
Published: December 2020

Background

In oral candidiasis models, Candida albicans and Streptococcus salivarius sp. biofilms have an antagonistic relationship. Due to this, S. salivarius have been used experimentally as probiotic. However, the interaction between these microorganisms in the peri-implantitis-like microenvironment remains unknown. This study aimed to evaluate the interaction between C. albicans and S. salivarius biofilms developed on titanium surfaces, under reduced oxygen levels.

Methods

Titanium specimens were pre-conditioned with artificial saliva (1 h, 37 °C). Single-species biofilms of C. albicans (ATCC 90028) and co-culture biofilms of C. albicans and S. salivarius (ATCC 7073) was developed for 24 and 72 h on titanium specimens. Subsequently, the effect of these intervals of biofilm formation and the interactions among the cells were evaluated. Biofilms from cultures were collected and analyzed for cell viability (CFU/mL), biofilm biomass, and total protein dosage. Data were analyzed using Mann–Whitney test (α = 5%). In addition, co-culture biofilms were analyzed using fluorescence microscopy.

Results

C. albicans growth did not change due to the presence of S. salivarius. Besides, co-culture biofilms showed a significant difference in the number of viable cells between 24 and 72 h of biofilm development (p < 0.05). The highest biofilm biomass and protein dosage were observed in co-cultures at 72 h of biofilm development. Fluorescence microscopy showed that co-cultures biofilms at 24 h have limited number of pseudo-hyphal and hyphae cells of C. albicans. At 72 h, these types of cells have increased. S. salivarius in both stages of development was present in some clusters surrounded by C. albicans.

Conclusions

Co-cultivation of C. albicans with S. salivarius in biofilms developed on titanium surfaces, under lower oxygen levels, did not affect fungus growth. In addition, S. salivarius did not hind C. albicans virulence. These findings suggest that the use of S. salivarius as a probiotic would be ineffective in peri-implant disease treatment.
Digital three-dimensional visualization of intrabony periodontal defects for regenerative surgical treatment planning
Authors: Palkovics Daniel , Mangano Francesco Guido , Nagy Katalin , Windisch Peter
Published: December 2020

Background

In the regenerative treatment of intrabony periodontal defects, surgical strategies are primarily determined by defect morphologies. In certain cases, however, direct clinical measurements and intraoral radiographs do not provide sufficient information on defect morphologies. Therefore, the application of cone-beam computed tomography (CBCT) has been proposed in specific cases. 3D virtual models reconstructed with automatic thresholding algorithms have already been used for diagnostic purposes. The aim of this study was to utilize 3D virtual models, generated with a semi-automatic segmentation method, for the treatment planning of minimally invasive periodontal surgeries and to evaluate the accuracy of the virtual models, by comparing digital measurements to direct intrasurgical measurements.

Methods

Four patients with a total of six intrabony periodontal defects were enrolled in the present study. Two months following initial periodontal treatment, a CBCT scan was taken. The novel semi-automatic segmentation method was performed in an open-source medical image processing software (3D Slicer) to acquire virtual 3D models of alveolar and dental structures. Intrasurgical and digital measurements were taken, and results were compared to validate the accuracy of the digital models. Defect characteristics were determined prior to surgery with conventional diagnostic methods and 3D virtual models. Diagnostic assessments were compared to the actual defect morphology during surgery.

Results

Differences between intrasurgical and digital measurements in depth and width of intrabony components of periodontal defects averaged 0.31 ± 0.21 mm and 0.41 ± 0.44 mm, respectively. In five out of six cases, defect characteristics could not be assessed precisely with direct clinical measurements and intraoral radiographs. 3D models generated with the presented semi-automatic segmentation method depicted the defect characteristics correctly in all six cases.

Conclusion

It can be concluded that 3D virtual models acquired with the described semi-automatic segmentation method provide accurate information on intrabony periodontal defect morphologies, thus influencing the treatment strategy. Within the limitations of this study, models were found to be accurate; however, further investigation with a standardized validation process on a large number of participants has to be conducted.
“I did not plan to have a baby. This is the outcome of our work”: a qualitative study exploring unintended pregnancy among female sex workers
Authors: Faini Diana , Munseri Patricia , Bakari Muhammad , Sandström Eric , Faxelid Elisabeth , Hanson Claudia
Published: December 2020

Background

High number of unintended pregnancies—often leading to induced abortions—are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW’s pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW’s pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use.

Methods

We conducted in-depth interviews with 11 FSWs (January–June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software.

Results

FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs’ commitment to good contraceptive practices.

Conclusion

Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.