bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kidney Transplantation in HIV-positive Patients: Current Practice and Management Strategies
Authors: Muller Elmi , Botha Francois C. J. , Barday Zunaid A. , Manning Kathryn , Chin-Hong Peter , Stock Peter 
Published: October 2020

Background.
HIV-positive patients had been successfully transplanted for the last 15 y and the donor pool had successfully been expanded to also include HIV-positive donors.

Methods.
We aimed to evaluate the effectiveness of transplantation in HIV-positive patients and highlight some of the important issues reported in the literature. We pooled clinical data from different cohorts to show some of the common issues encountered in HIV-positive transplantation. Furthermore, we searched MEDLINE via PubMed, EMBASE, Cochrane CENTRAL to create a comprehensive table for current evidence for different issues currently encountered when transplanting HIV-positive patients.

Results.
We included data from 19 cohort studies and reported on outcomes of the current HIV-positive transplant programs. We made recommendations based on personal experience as well as the experience reported in the literature regarding rejection, opportunistic infection, and HIV-associated nephropathy. Opportunistic infections and malignancies are not a major problem for this population group.

Conclusions.
HIV-positive patients encounter very specific issues after transplantation, specifically related to drug interactions and higher rejection rates. When utilizing HIV-positive donors, the recurrence of HIV-associated nephropathy in the graft kidney is an issue which can be important. Despite some issues with high rejection rates, HIV-positive patients have similar results to HIV-negative patients posttransplantation.
The Potential Role of Efficacy and Safety Evaluation of N-Acetylcysteine Administration During Liver Procurement. The NAC-400 Single Center Randomized Controlled Trial
Authors: Gómez-Gavara Concepción , Moya-Herraiz Ángel , Hervás David , Pérez-Rojas Judith , LaHoz Agustín , López-Andújar Rafael 
Published: October 2020

Background.
N-acetylcysteine infusions have been widely used to reduce ischemia/reperfusion damage to the liver; however, convincing evidence of their benefits is lacking.

Objective.
To perform the largest randomized controlled trial to compare the impact of N-acetylcysteine infusion during liver procurement on liver transplant outcomes.

Methods.
Single center, randomized trial with patients recruited from La Fe University Hospital, Spain, from February 2012 to January 2016. A total of 214 grafts were transplanted and randomized to the N-acetylcysteine group (n = 113) or to the standard protocol without N-acetylcysteine (n = 101). The primary endpoint was allograft dysfunction (Olthoff criteria). Secondary outcomes included metabolomic biomarkers of oxidative stress levels, interactions between cold ischemia time and alanine aminotransferase level and graft and patient survival (ID no. NCT01866644).

Results.
The incidence of primary dysfunction was 34% (31% in the N-acetylcysteine group and 37.4% in the control group [P = 0.38]). N-acetylcysteine administration reduced the alanine aminotransferase level when cold ischemia time was longer than 6 h (P = 0.0125). Oxidative metabolites (glutathione/oxidized glutathione and ophthalmic acid) were similar in both groups (P > 0.05). Graft and patient survival rates at 12 mo and 3 y were similar between groups (P = 0.54 and P = 0.69, respectively).

Conclusions.
N-acetylcysteine administration during liver procurement does not improve early allograft dysfunction according to the Olthoff classification. However, when cold ischemia time is longer than 6 h, N-acetylcysteine improves postoperative ALT levels.
MRI in disorders of consciousness
Authors: Snider Samuel B. , Edlow Brian L. 
Published: October 2020

Purpose of review
In the study of brain-injured patients with disorders of consciousness (DoC), structural and functional MRI seek to provide insights into the neural correlates of consciousness, identify neurophysiologic signatures of covert consciousness, and identify biomarkers for recovery of consciousness.

Recent findings
Cortical volume, white matter volume and integrity, and structural connectivity across many grey and white matter regions have been shown to vary with level of awareness in brain-injured patients. Resting-state functional connectivity (rs-FC) within and between canonical cortical networks also correlates with DoC patients’ level of awareness. Stimulus-based and motor-imagery fMRI paradigms have identified some behaviorally unresponsive DoC patients with cortical processing and activation patterns that mirror healthy controls. Emerging techniques like dynamic rs-FC have begun to identify temporal trends in brain-wide connectivity that may represent novel neural correlates of consciousness.

Summary
Structural and functional MRI will continue to advance our understanding of brain regions supporting human consciousness. Measures of regional and global white matter integrity and rs-FC in particular networks have shown significant improvement over clinical features in identifying acute and chronic DoC patients likely to recover awareness. As they are refined, functional MRI paradigms may additionally provide opportunities for interacting with behaviorally unresponsive patients.
Relationship Between Brainstem Auditory Evoked Potentials and Clinical Function in Patients With Cerebral Infarction
Authors: Kim Yeong-Wook , Sohn Min Kyun , Jung Il-Young 
Published: October 2020

Purpose:
The purpose of this study was to analyze the association between the brainstem auditory evoked potential (BAEP) and clinical outcomes at discharge in patients who have had subacute ischemic stroke.

Methods:
A total of 210 patients who have had ischemic stroke, confirmed by MRI within 3 months after onset, were enrolled. Demographics and stroke-related clinical assessment scales, such as the modified Barthel index and National Institute of Health Stroke Scale (NIHSS), were collected. Recorded latencies of waveforms I, III, and V of BAEP were bilaterally collected and analyzed. The results of the patients with supratentorial brain lesions were further analyzed.

Results:
The mean BAEP latencies of waveforms I, III, and V in the subjects were 1.84 ± 0.22, 4.07 ± 0.27, and 6.07 ± 0.33 ms, respectively. As the modified Barthel index and NIHSS scores at discharge functionally worsened, the latencies of all lesion-side BAEP waveforms were significantly delayed. In patients with supratentorial brain lesions only, there was a significant delay in the latency of waveform V at the lesion side as modified Barthel index severity increased (P = 0.048). As the NIHSS score functionally worsened, BAEP latencies III and V recorded at the lesion side significantly delayed (P = 0.023 and P = 0.003, respectively). In multivariate linear regression models, latency V was found to be a significant factor in predicting outcome at discharge, among other factors.

Conclusions:
In patients with ischemic stroke with the poor clinical outcome at discharge, there were delayed latencies of waveforms I, III, and V of BAEP performed in the early phase of stroke.
Extended laboratory panel testing in the Emergency Department for risk-stratification of patients with COVID-19: a single centre retrospective service evaluation
Authors: Ponsford Mark J , Burton Ross J , Smith Leitchan , Khan Palwasha , Andrews Robert , Cuff Simone , Tan Laura , Eberl Matthias , Humphreys Ian R , Babolhavaeji Farbod , Artemiou Andreas , Pandey Manish , Jolles Stephen , Underwood Jonathan 
Published: October 2020

BackgroundThe role of specific blood tests to predict poor prognosis in patients admitted with infection from SARS-CoV2 virus remains uncertain. During the first wave of the global pandemic, an extended laboratory testing panel was integrated into the local pathway to guide triage and healthcare resource utilisation for emergency admissions. We conducted a retrospective service evaluation to determine the utility of extended tests (D-dimer, ferritin, high-sensitivity troponin I, lactate dehydrogenase, procalcitonin) compared to the core panel (full blood count, urea & electrolytes, liver function tests, C-reactive protein).MethodsClinical outcomes for adult patients with laboratory-confirmed COVID-19 admitted between 17th March to 30st June 2020 were extracted, alongside costs estimates for individual tests. Prognostic performance was assessed using multivariable logistic regression analysis with 28-day mortality used as the primary endpoint, and a composite of 28-day intensive care escalation or mortality for secondary analysis.ResultsFrom 13,500 emergency attendances we identified 391 unique adults admitted with COVID-19. Of these, 113 died (29%) and 151 (39%) reached the composite endpoint. “Core” test variables adjusted for age, gender and index of deprivation had a prognostic AUC of 0.79 (95% Confidence Interval, CI: 0.67 to 0.91) for mortality and 0.70 (95% CI: 0.56 to 0.84) for the composite endpoint. Addition of “extended” test components did not improve upon this.ConclusionOur findings suggest use of the extended laboratory testing panel to risk stratify community-acquired COVID-19-positive patients on admission adds limited prognostic value. We suggest laboratory requesting should be targeted to patients with specific clinical indications.
DEVELOPING AND VALIDATING COVID-19 ADVERSE OUTCOME RISK PREDICTION MODELS FROM A BI-NATIONAL EUROPEAN COHORT OF 5594 PATIENTS
Authors: Jimenez-Solem Espen , Petersen Tonny S , Hansen Casper , Hansen Christian , Lioma Christina , Igel Christian , Boomsma Wouter , Krause Oswin , Lorenzen Stephan , Selvan Raghavendra , Petersen Janne , Nyeland Martin Erik , Zöllner Ankarfeldt Mikkel , Virenfeldt Gert Mehl , Winther-Jensen Matilde , Linneberg Allan , Ghazi Mostafa Mediphour , Detlefsen Nicki , Lauritzen Andreas , Smith Abraham George , de Bruijne Marleen , Ibragimov Bulat , Petersen Jens , Lillholm Martin , Middleton Jon , Mogensen Stine Hasling , Thorsen-Meyer Hans-Christian , Perner Anders , Helleberg Marie , Kaas-Hansen Benjamin Skov , Bonde Mikkel , Bonde Alexander , Pai Akshay , Nielsen Mads , Sillesen Martin 
Published: October 2020

ABSTRACTBackgroundPatients with severe COVID-19 have overwhelmed healthcare systems worldwide. We hypothesized that Machine Learning (ML) models could be used to predict risks at different stages of management (at diagnosis, hospital admission and ICU admission) and thereby provide insights into drivers and prognostic markers of disease progression and death.MethodsFrom a cohort of approx. 2.6 million citizens in the two regions of Denmark, SARS-CoV-2 PCR tests were performed on subjects suspected for COVID-19 disease; 3944 cases had at least one positive test and were subjected to further analysis. A cohort of SARS- CoV-2 positive cases from the United Kingdom Biobank was used for external validation.FindingsThe ML models predicted the risk of death (Receiver Operation Characteristics – Area Under the Curve, ROC-AUC) of 0.904 at diagnosis, 0.818, at hospital admission and 0.723 at Intensive Care Unit (ICU) admission. Similar metrics were achieved for predicted risks of hospital and ICU admission and use of mechanical ventilation. We identified some common risk factors, including age, body mass index (BMI) and hypertension as driving factors, although the top risk features shifted towards markers of shock and organ dysfunction in ICU patients. The external validation indicated fair predictive performance for mortality prediction, but suboptimal performance for predicting ICU admission.InterpretationML may be used to identify drivers of progression to more severe disease and for prognostication patients in patients with COVID-19. Prognostic features included age, BMI and hypertension, although markers of shock and organ dysfunction became more important in more severe cases.We provide access to an online risk calculator based on these findings.FundingThe study was funded by grants from the Novo Nordisk Foundation to MS (#NNF20SA0062879 and #NNF19OC0055183) and MN (#NNF20SA0062879). The foundation took no part in project design, data handling and manuscript preparation.
Enoxaparin is associated with lower rates of thrombosis, kidney injury, and mortality than Unfractionated Heparin in hospitalized COVID patients
Authors: Pawlowski Colin , Venkatakrishnan AJ , Kirkup Christian , Berner Gabriela , Puranik Arjun , O’Horo John C. , Badley Andrew D. , Soundararajan Venky 
Published: October 2020

AbstractAlthough anticoagulants such as unfractionated heparin and low molecular weight heparin (LMWH, e.g. enoxaparin) are both being used for therapeutic mitigation of COVID associated coagulopathy (CAC), differences in their clinical outcomes remain to be investigated. Here, we employ automated neural networks supplemented with expert curation (‘augmented curation’) for retrospectively analyzing the complete electronic health records (EHRs) of 671 hospitalized COVID-19 patients administered either enoxaparin or unfractionated heparin, but not both. We find that COVID-19 patients administered unfractionated heparin but not enoxaparin have higher rates of mortality (risk ratio: 2.6; 95% C.I.: [1.2-5.4]; p-value: 0.02; BH adjusted p-value: 0.09), thrombotic events (risk ratio: 5.7, 95% C.I.: [2.1, 33.9], p-value: 0.024), acute kidney injury (risk ratio: 5.5; 95% C.I.: [1.2-17.7]; p-value: 0.02; BH adjusted p-value: 0.10), and bacterial pneumonia (risk ratio undefined; 95% C.I.: [1.0, 292]; p-value:0.02; BH adjusted p-value:0.10), compared to patients administered enoxaparin but not unfractionated heparin. Notably, even after controlling for potential confounding factors such as demographics, comorbidities, admission diagnosis, initial ICU status, and initial level of oxygen support, the above differences between the enoxaparin and unfractionated heparin patient cohorts remain statistically significant. This study emphasizes the need for mechanistically investigating differential modulation of the COVID-associated coagulation cascades by enoxaparin versus unfractionated heparin.
Lockdown impact on age-specific contact patterns and behaviours in France
Authors: Bosetti Paolo , Huynh Bich-Tram , Abdou Armiya Youssouf , Sanchez Marie , Eisenhauer Catherine , Courtejoie Noémie , Accardo Jérôme , Salje Henrik , Guillemot Didier , Moslonka-Lefebvre Mathieu , Boëlle Pierre-Yves , Béraud Guillaume , Cauchemez Simon , Opatowski Lulla 
Published: October 2020

AbstractIn the first trimester 2020, a significant number of countries implemented general lockdowns of their populations to contain the quickly expanding SARS-CoV-2 epidemic and avoid major saturation of health care capacity. Understanding how these unprecedented measures impacted population behaviour and contact patterns is key to predict more accurately the health, social and economic impacts of such extreme actions if they were to be applied to future outbreaks. We set up an online survey to measure how the lockdown affected social contact patterns in France, and collected information from 42,036 participants aged 18 years and over between April 10 and April 28, 2020. Among the participants who normally worked outside home prior to the lockdown (72% of the survey population), 68% reported that they had moved to working from home and 17% reported being unemployed during the lockdown.Only 2% of participants used public transport during lockdown, as opposed to 37% before it. Participants reported increased frequency of washing hands, switch in greeting behaviour, but generally limited use of masks outside home. 138,934 contacts were reported, with an average 3.3 contacts per individual per day (1.7 for individuals aged >65 years old compared to 3.6 for younger age-groups). This represented a 70% reduction compared with previous surveys, consistent with reductions in transmission rates measured during the lockdown. Contacts in workplaces, shops, and transports on the previous day were respectively reported in only 11%, 31% and 0.5% of the participants. For those who maintained a professional activity outside home, the frequency of contacts at work dropped by 79%. This study shows that the lockdown dramatically affected population’s behavior, work, risk perception and contact patterns. Both frequency and heterogeneity of contacts were affected, impacting potential important features of virus dissemination. Such surveys are essential to evaluate more accurately the impact of past or future lockdowns and anticipate epidemic dynamics in these conditions.
A Comparative COVID 19 Characterizations and Clinical Course Analysis between ICU and Non ICU Settings
Authors: Patel Amit , Bhatt Parloop , Madan Surabhi , Shah Nitesh , Thakkar Vipul , Shah Bhagyesh , Chovatia Rashmi , Shah Hardik , Patel Minesh , Dabhi Pradip , Nanavati Aditi , Chag Milan , Parikh Keyur 
Published: October 2020

AbstractObjectiveWith COVID-19 pandemic severely affecting India and Ahmedabad city being one accounting for half COVID cases, objective was to determine disease course and severity of in patients at a COVID care hospital.DesignA Clinical trial registry of India registered observational study (CTRI/2020/05/025247).SettingCertified COVID hospital located in Ahmedabad, Gujarat, India.Participants549 COVID positive patients hospitalized between 15 th May to 10 th August, 2020 and treated in ICU and non ICU settings.Main Outcome MeasureComparative analysis of demographic, clinical characteristics, investigations, treatment, complications and outcome of COVID patients in ICU and non ICU settings.ResultsOf the 549 hospitalized COVID positive patients, 159 were admitted in ICU during disease course while 390 had ward admissions. Overall median age was 52 (1-86) years. The ICU group was older (>65years), with associated comorbidities like hypertension and diabetes (p<0.001); higher proportion of males (79.25%); with dyspnea as a major clinical characteristic and consolidation in lungs as a major radiological finding as compared to ward patients. C - reactive protein, D-Dimer and Ferritin were higher in ICU patients. Overall 50% females depicted elevated Ferritin levels. Steriods(92.45%)and tocilizumab (69.18%) were more frequently used for ICU patients. Remdesivir was prescribed to both ICU and non ICU patients. Favirapir was also a line of treatment for 25% of ICU patients. Convalescent plasma therapy was given to 7 ICU patients. Complications like acute kidney injury (13.84%), shock (10.69 %), sepsis and encephalopathy were observed in ICU patients. Overall mortality rate was 5.47 % with higher mortality among males in comparison to females (p<0.0001).ConclusionAbout 29% of overall patients required ICU admission that was commonly elderly males. Chances of ICU admission were higher with baselines comorbidities (1.5 times) and dyspnea (3.4 times) respectively. A multi-specialty COVID care team and updated treatment protocols improves outcomes.
Assessing the Impact of Area Deprivation Index on COVID-19 Prevalence: A Contrast Between Rural and Urban U.S. Jurisdictions
Authors: Kitchen Christopher , Hatef Elham , Chang Hsien-Yen , Weiner Jonathan , Kharrazi Hadi 
Published: October 2020

ABSTRACTBackgroundThe COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S.ObjectivesTo understand the spread and impact of COVID-19 across the U.S., county level data for confirmed cases of COVID-19 were examined by Area Deprivation Index (ADI) scores and Metropolitan vs. Nonmetropolitan designations from the National Center for Health Statistics (NCHS). These designations were the basis for making comparisons between Urban and Rural jurisdictions.MethodsKendall’s Tau-B was used to compare effect sizes between jurisdictions on select ADI composites and well researched social determinants of health (SDH). Spearman coefficients and a moderation analysis using Poisson modeling was used to explore the relationship between ADI and COVID-19 prevalence in the context of county designation.ResultsResults show that the relationship between area deprivation and COVID-19 prevalence was positive and higher for rural counties, when compared to urban ones and that family income and poverty had a stronger relationship with prevalence than other ADI component measures.ConclusionsThough most Americans live in Metropolitan Areas, rural communities were found to be associated with a stronger relationship between deprivation and COVID-19 prevalence. Models for predicting COVID-19 prevalence by ADI and county type reinforced this observation but revealed no moderating effect of county type on ADI.
Diagnostic Accuracy of FDA Authorized Serology Tests to Detect SARS-CoV-2 Antibodies: A Systematic Review and Meta-analysis
Authors: Pandey Rajesh , Gourishankar Anand 
Published: October 2020

AbstractImportanceSerology tests are diagnostic and complementary to molecular tests during the COVID-19 pandemic.ObjectiveTo evaluate the diagnostic accuracy of FDA authorized serology tests for the detection of SARS-CoV-2 infection.Data sourcesA search of MEDLINE, SCOPUS, CINAHL Plus, and EMBASE up to April 4, 2020, was performed to identify studies using the “COVID 19 testing” and “meta-analysis.” FDA website was accessed for the list of tests for emergency use authorization (EUA).Study SelectionManufacturer reported serology tests published in the FDA website were selected. Two reviewers independently assessed the eligibility of the selected reports.Data extraction and synthesisThe meta-analysis was performed in accordance with the PRISMA guidelines. A bivariate analysis using the “random-effects model” was applied for pooled summary estimates of sensitivity, specificity, and the summary receiver operating characteristic curves.Main outcomes and measuresThe primary outcome was the diagnostic accuracy of the serology test for detecting SARS-CoV-2 infection. Subgroup analysis of the diagnostic accuracy with lag time between symptom onset and testing were studied.ResultsSeven manufacturer listed reports were included. The pooled sensitivity was 87% (95% CI, 78% - 93%), the pooled specificity was 100% (95% CI, 97% - 100%), and the area under the hierarchical summary receiver operating characteristic curve was 0.97. At ≤ 7 days, sensitivity was 44% (95% CI, 21% - 70%), and for 8-14 days, sensitivity was 84% (95% CI, 67 % - 94%).For blood draws ≥ 15 days after the onset of symptoms, sensitivity was 96% (95% CI, 93% - 98%). Heterogeneity was substantial, and the risk of bias was low in this analysis.Conclusions and relevanceFDA authorized serology tests demonstrate high diagnostic accuracy for SARS-CoV-2 infection (certainty of evidence: moderate). There is a wide variation in the test accuracy based on the duration between the onset of symptoms and the tests (certainty of evidence: low).Key– pointsQuestionsWhat is the pooled diagnostic accuracy of FDA authorized serology tests to detect SARS-CoV-2 antibodies?FindingsIn this systematic review and meta-analysis of seven reports from FDA authorized serology tests to detect antibodies against SARS-CoV2 antibodies (3336 patients/ samples) pooled sensitivity was 87%, and pooled specificity was almost 100%. There was a wide variation in test performance based on the duration between the onset of symptoms and the tests.MeaningFDA authorized tests are highly accurate to detect antibodies against SARS-CoV-2 antibodies if tests are performed under a similar condition, as presented in the original report. There is a wide variation in the test performance based on the time interval between the onset of symptoms to the tests.