bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing ofM. tuberculosisexposure explains variation in BCG effectiveness: A systematic review and meta-analysis
Authors: Trauer James M , Kawai Andrew , Coussens Anna , Datta Manjula , Williams Bridget M , McBryde Emma S , Ragonnet Romain 
Published: November 2020

AbstractBackgroundThe variable efficacy observed in studies of BCG vaccination is incompletely explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure. We investigated heterogeneity in BCG vaccination in the context of participant demography, diagnostic approach and TB-related epidemiological context.MethodsWe updated previous systematic reviews of the effectiveness of BCG vaccination to 31stDecember 2018. We employed an identical search strategy and inclusion/exclusion criteria to past reviews, but reclassified several studies and developed an alternative classification system.ResultsOf 21 included trials, those recruiting neonates and children aged under five were consistent in demonstrating considerable protection for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period.ConclusionsThe most plausible explanatory hypothesis is that BCG protects against TB that results from exposure shortly after vaccination. However, risk is equivalent or increased when exposure occurs later from vaccination, a phenomenon which is predominantly observed in adults in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines due to repeated exposure toM. tuberculosisor other pathogens.
Clinic audit on Chronic Obstructive Pulmonary Disease (COPD) management in public primary care setting: Hong Kong experience
Authors: Rui Catherine Chen Xiao , Nga Fu Sau , Kit Leung Wing , Wing Catherine Ng Sze , Yan Wendy Kwan Wing , Kwong Wong Tseng , Fai Chan Pang , Ying Michelle Wong Man , Kit Welchie Ko Wai , Jun Liang , Tung Eric Hui Ming , Chu Li Yim , Wan Luk , David Chao VK 
Published: November 2020

AbstractBackgroundChronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care and presents a substantial burden to the health care system. This study aimed to audit COPD care at all public primary care clinics of Hong Kong and to work out improvement strategies.MethodThe computer record of COPD patients aged 40 or above and had been followed up at any of the 73 public primary care clinics under the Hospital Authority of Hong Kong (HAHK) were reviewed. Evidence-based audit criteria and performance standards were established after thorough literature review. In the first phase from 1st April 2017 to 31st March 2018, deficiencies of care were identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the service enhancement was assessed in the second phase from 1st April 2019 to 31st March 2020. Student’s t test and Chi-square test were used to identify any statistically significant changes between the two.ResultsTotally 10,385 COPD cases were identified in Phase 1, among whom 3,102 (29.9%) were active smokers. Most of the patients were male (87.7%) and the mean age was 75.3±9.9 years old. Of those smokers, 1,788 (57.6%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 1,578 (50.9%) actually attended it. 4,866 cases (46.9%) received Seasonal Influenza Vaccine (SIV) and 4,227 cases (40.7%) received Pneumococcal Vaccine (PCV). 1,983 patients (19.1%) had spirometry done before and 1,327 patients (12.8%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed a significant improvement in all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (9.6%, P<0.00001).ConclusionCOPD care at all public primary care clinics of HAHK had been significantly improved for all audit criteria via the systematic team approach, which in turn reduced the hospital admission rate and helped relieve the burden of the healthcare system.
Predicting critical illness on initial diagnosis of COVID-19 based on easily-obtained clinical variables: Development and validation of the PRIORITY model
Authors: Martinez-Lacalzada Miguel , Adrián Viteri-Noël Luis , Manzano Luis , Fabregate-Fuente Martin , Rubio-Rivas Manuel , Garcia Sara Luis , Fernández Francisco Arnalich , Beato Pérez José Luis , Núñez Juan Antonio Vargas , Manuel Elpidio Calvo , Espiño Álvarez Alexia Constanza , Castro Santiago J. Freire , Loureiro-Amigo Jose , Fontan Paula Maria Pesqueira , Pina Adela , María Álvarez Suárez Ana , Asiain Andrea Silva , García López Beatriz , del Pino Jairo Luque , Cánovas Jaime Sanz , Pérez Paloma Chazarra , María García García Gema , Núñez-Cortés Jesús Millán , Casas Rojo José Manuel , Gómez Huelgas Ricardo ,   for the SEMI-COVID-19 Network
Published: November 2020

ABSTRACTObjectivesCurrently available COVID-19 prognostic models have focused on laboratory and radiological data obtained following admission. However, these tests are not available on initial assessment or in resource-limited settings. We aim to develop and validate a prediction model, based on clinical history and examination findings on initial diagnosis of COVID-19, to identify patients at risk of critical outcomes.MethodsWe used data from the SEMI-COVID-19 Registry, a nationwide multicenter cohort of consecutive patients hospitalized for COVID-19 from 132 centers in Spain. Clinical signs and symptoms, demographic variables, and medical history ascertained at hospital admission were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive model. We externally validated the final model in a separate cohort of patients admitted at less-complex hospitals (< 300 beds).We undertook decision curve analysis to assess the clinical usefulness of the predictive model. The primary outcome was a composite of in-hospital death, mechanical ventilation or admission to intensive care unit.ResultsThere were 10,433 patients, 7,850 (primary outcome 25.1%) in the development cohort and 2,583 (primary outcome 27.0%) in the validation cohort. Variables in the final model included: age, cardiovascular disease, chronic kidney disease, dyspnea, tachypnea, confusion, systolic blood pressure, and SpO2≤93% or oxygen requirement.The C-statistic in the development cohort was 0.823 (95% CI,0.813-0.834). On external validation, the C-statistic was 0.792 (95% CI,0.772-0.812). The model showed a positive net benefit for threshold probabilities between 3% and 79%.ConclusionsAmong patients presenting with COVID-19, the model based on easily-obtained clinical information had good discrimination and generalizability for identifying patients at risk of critical outcomes without the need of additional testing. The online calculator provided would facilitate triage of patients during the pandemic. This study could provide a useful tool for decision-making in health systems under pandemic pressure and resource-limited settings.
Dietary supplements during the COVID-19 pandemic: insights from 1.4M users of the COVID Symptom Study app - a longitudinal app-based community survey
Authors: Louca Panayiotis , Murray Benjamin , Klaser Kerstin , Graham Mark S , Mazidi Mohsen , Leeming Emily R , Thompson Ellen , Bowyer Ruth , Drew David A , Nguyen Long H , Merino Jordi , Gomez Maria , Mompeo Olatz , Costeira Ricardo , Sudre Carole H , Gibson Rachel , Steves Claire J , Wolf Jonathan , Franks Paul W , Ourselin Sebastien , Chan Andrew T , Berry Sarah E , Valdes Ana M , Calder Philip C , Spector Tim D , Menni Cristina 
Published: November 2020

AbstractObjectivesDietary supplements may provide nutrients of relevance to ameliorate SARS-CoV-2 infection, although scientific evidence to support a role is lacking. We investigate whether the regular use of dietary supplements can reduce the risk of testing positive for SARS-CoV-2 infection in around 1.4M users of the COVID Symptom Study App who completed a supplement use questionnaire.DesignLongitudinal app-based community survey and nested case control study.SettingSubscribers to an app that was launched to enable self-reported information related to SARS-CoV-2 infection for use in the general population in three countries.Main ExposureSelf-reported regular dietary supplement usage since the beginning of the pandemic.Main Outcome MeasuresSARS-CoV-2 infection confirmed by viral RNA polymerase chain reaction test (RT-PCR) or serology test. A secondary outcome was new-onset anosmia.ResultsIn an analysis including 327,720 UK participants, the use of probiotics, omega-3 fatty acids, multivitamins or vitamin D was associated with a lower risk of SARS-CoV-2 infection by 14%(95%CI: [8%,19%]), 12%(95%CI: [8%,16%]), 13%(95%CI: [10%,16%]) and 9%(95%CI: [6%,12%]), respectively, after adjusting for potential confounders. No effect was observed for vitamin C, zinc or garlic supplements. When analyses were stratified by sex, age and body mass index (BMI), the protective associations for probiotics, omega-3 fatty acids, multivitamins and vitamin D were observed in females across all ages and BMI groups, but were not seen in men. The same overall pattern of association was observed in both the US and Swedish cohorts. Results were further confirmed in a sub-analysis of 993,365 regular app users who were not tested for SARS-CoV-2 with cases (n= 126,556) defined as those with new onset anosmia (the strongest COVID-19 predictor).ConclusionWe observed a modest but significant association between use of probiotics, omega-3 fatty acid, multivitamin or vitamin D supplements and lower risk of testing positive for SARS-CoV-2 in women. No clear benefits for men were observed nor any effect of vitamin C, garlic or zinc for men or women. Randomised controlled trials of selected supplements would be required to confirm these observational findings before any therapeutic recommendations can be made.
Prevalence of SARS-CoV-2 in household members and other close contacts of COVID-19 cases: a serologic study in canton of Vaud, Switzerland
Authors: Dupraz Julien , Butty Audrey , Duperrex Olivier , Estoppey Sandrine , Faivre Vincent , Thabard Julien , Zuppinger Claire , Greub Gilbert , Pantaleo Giuseppe , Pasquier Jérôme , Rousson Valentin , Egger Malik , Steiner-Dubuis Amélie , Vassaux Sophie , Masserey Eric , Bochud Murielle , Nusslé Semira Gonseth , D’Acremont Valérie 
Published: November 2020

AbstractBackgroundUnderstanding community-based SARS-CoV-2 transmission is crucial to inform public health decisions. Research on SARS-CoV-2 transmission within households and other close settings using serological testing is scarce.MethodsWe invited COVID-19 cases diagnosed between February 27 and April 1, 2020 in canton of Vaud, Switzerland, to participate, along with household members and other close contacts. Anti-SARS-CoV-2 IgG antibodies were measured using a Luminex immunoassay. We estimated factors associated with serological status using generalized estimating equations.FindingsOverall, 219 COVID-19 index cases, 302 household members, and 69 other close contacts participated between May 4 and June 27, 2020. More than half of household members (57·2%, 95%CI 49·7-64·3) had developed a serologic response to SARS-CoV-2, while 19·0% (95%CI 10·0-33·2) of other close contacts were seropositive. After adjusting for individual and household characteristics, infection risk was higher in household members aged 65 or more than in younger adults (aOR 3·63, 95%CI 1·05-12·60), and in those not strictly adhering to simple hygiene rules like hand washing (aOR 1·80, 95%CI 1·02-3·17). The risk was lower when more than 5 people outside home were met during the semi-confinement, compared to none (aOR 0·35, 95%CI 0·16-0·74). The individual risk of household members to be seropositive was lower in large households (22% less per each additional person).InterpretationWe find that, during semi-confinement, household members of a COVID-19 case were at very high risk of getting infected, 3 times more than close contacts outside home. This highlights the need to provide clear messages on specific protective measures applicable at home. For elderly couples, who were especially at risk, providing them external support for daily basic activities is essential.FundingCenter for Primary Care and Public Health (Unisanté), Canton of Vaud, Leenaards Foundation, Fondation pour l’Université de Lausanne. SerocoViD is part of Corona Immunitas coordinated by SSPH+.
The Prophylactic Effect of Oral Olanzapine on Postoperative Nausea and Vomiting in Laparoscopic Gynecological Surgery: A Randomized Clinical Trial
Authors: Seki Hiroyuki , Kuratani Norifumi , Shiga Toshiya , Miura Norikazu , Kondo Ichiro , Kinoshita Mao , Sento Yoshiki , Masuda Yuya , Ideno Sathoshi , Ikeda Kohei , Takano Koji , Kuwabara Yuuki , Kinugasa Rie , Amaya Fumimasa , Sawa Teiji , Sobue Kazuya , Morisaki Hiroshi 
Published: November 2020

AbstractBackgroundAlthough the antiemetic effect of olanzapine on chemotherapy-induced nausea and vomiting has been characterized, the prophylactic role of olanzapine on postoperative nausea and vomiting (PONV) has not been fully elucidated. This clinical trial aims to examine the effectiveness of olanzapine for preventing PONV.MethodsPatients undergoing laparoscopic gynecological surgery at 5 university hospitals in Japan will be randomly assigned to receive either 5 mg of oral olanzapine or placebo 2 hours before the induction of anesthesia. All patients will receive intravenous dexamethasone at the induction of anesthesia. The primary outcome will be the incidence of postoperative nausea and vomiting within 24 hours after surgery. Secondary endpoints will include longitudinal changes in the incidence of postoperative nausea and vomiting and overall patient satisfaction.DiscussionThis trial will provide a high quality evidence whether olanzapine prevents PONV in gynecological laparoscopy patients at a high risk for PONV.Ethics and disseminationThe trial was approved by the institutional review board of the each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations.Trial registrationUMIN Clinical Trials Registry (UMIN-CTR) ID: 000022634, Registered on October 1, 2016 https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000026031
Evaluation of four commercial, fully automated SARS-CoV-2 antibody tests suggests a revision of the Siemens SARS-CoV-2 IgG assay
Authors: Irsara Christian , Egger Alexander E. , Prokop Wolfgang , Nairz Manfred , Loacker Lorin , Sahanic Sabina , Sonnweber Thomas , Mayer Wolfgang , Schennach Harald , Loeffler-Ragg Judith , Bellmann-Weiler Rosa , Tancevski Ivan , Weiss Günter , Anliker Markus , Griesmacher Andrea , Hoermann Gregor 
Published: November 2020

AbstractObjectivesSerological tests detect antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the ongoing coronavirus disease-19 (COVID-19) pandemic. Independent external clinical validation of performance characteristics is of paramount importance.MethodsFour fully automated assays, Roche Elecsys Anti-SARS-CoV-2, Abbott SARS-CoV-2 IgG, Siemens SARS-CoV-2 total (COV2T) and SARS-CoV-2 IgG (COV2G) were evaluated using 350 pre-pandemic samples and 700 samples from 245 COVID-19 patients (158 hospitalized, 87 outpatients).ResultsAll tests showed very high diagnostic specificity. Sensitivities in samples collected at least 14 days after disease onset were slightly lower than manufacturers’ claims for Roche (93.04%), Abbott (90.83%), and Siemens COV2T (90.26%), and distinctly lower for Siemens COV2G (78.76%). Concordantly negative results were enriched for immunocompromised patients. ROC curve analyses suggest a lowering of the cut-off index for the Siemens COV2G assay. Finally, the combination of two anti-SARS-CoV-2 antibody assays is feasible when considering borderline reactive results.ConclusionsThorough on-site evaluation of commercially available serologic tests for detection of antibodies against SARS-CoV-2 remains imperative for laboratories. The potentially impaired sensitivity of the Siemens COV2G necessitates a switch to the company’s newly filed SARS-CoV-2 IgG assay (sCOVG) for follow-up studies. A combination of tests could be considered in clinical practice.
Oncological outcomes of primary renal malignancies other than clear cell renal carcinoma: A retrospective study from a tertiary center
Authors: Mehra Ketan , Ramanitharan Manikandan , Narayanan Dorairajan Lalgudi , Sreenivasan Sreerag Kodakkattil , Kalra Sidhartha 
Published: November 2020

AbstractIntroductionA lot of research is available about clear cell renal carcinomas (ccRCC). But there are lesser known facts about other subtypes of renal malignancies. With advances in immunohistochemical and cytogenetic techniques, new variants of renal tumors are being increasingly reported. The treatment and prognosis of such rare malignancies is still an enigma. We performed this study to analyze the incidence, clinico-pathological features, surgical treatment, and survival of non-clear cell RCC at our institution.Materials and MethodsThe histopathological reports of 77 Nephrectomy specimens who underwent surgical treatment for suspected renal tumors from 2013-2018 were retrospectively reviewed. 19 (24%) of patients had documented uncommon histologic variants of RCC. The clinical, demographic, and histologic characteristics of these patients were analyzed, and survival was evaluated. The characteristic light microscopy and immunohistochemical features of these lesions were documented.ResultsMean age was 45 years (21-67 years). Out of 19 patients, 14 (73.6%) were males, and 5 (26.4%) were females. Mean tumor size was 12 (6-31) cm in the largest dimension. 17 (22%) patients underwent radical nephrectomy, and 2 (2.5%) were treated with partial nephrectomy. Patients with collecting duct, synovial sarcoma, and primitive neuro-ectodermal tumor (PNET) had associated inferior vena caval thrombus and underwent venous thrombectomy. Adjuvant treatment in the form of chemotherapy was instituted in collecting duct, adult Wilms and pure sarcomas. There was no mortality in the papillary carcinoma, and the worst prognosis was encountered inConclusionSarcomatoid and collecting duct variants were associated with worse prognosis. Presently, aggressive surgical extirpation is the mainstay in the management of these histologic variants. Adjuvant chemotherapy and TKI inhibitors have a limited role.
Routine saliva testing for the identification of silent COVID-19 infections in healthcare workers
Authors: Zhang Kevin , Shoukat Affan , Crystal William , Langley Joanne M. , Galvani Alison P. , Moghadas Seyed M. 
Published: November 2020

AbstractObjectiveCurrent COVID-19 guidelines recommend symptom-based screening and regular nasopharyngeal (NP) testing for healthcare personnel in high-risk settings. We sought to estimate case detection percentages with various routine NP and saliva testing frequencies.DesignSimulation modelling study.MethodsWe constructed a sensitivity function based on the average infectiousness profile of symptomatic COVID-19 cases to determine the probability of being identified at the time of testing. This function was fitted to reported data on the percent positivity of symptomatic COVID-19 patients using NP testing. We then simulated a routine testing program with different NP and saliva testing frequencies to determine case detection percentages during the infectious period, as well as the pre-symptomatic stage.ResultsRoutine bi-weekly NP testing, once every two weeks, identified an average of 90.7% (SD: 0.18) of cases during the infectious period and 19.7% (SD: 0.98) during the pre-symptomatic stage. With a weekly NP testing frequency, the corresponding case detection percentages were 95.9% (SD: 0.18) and 32.9% (SD: 1.23), respectively. A 5-day saliva testing schedule had a similar case detection percentage as weekly NP testing during the infectious period, but identified about 10% more cases (mean: 42.5%; SD: 1.10) during the pre-symptomatic stage.ConclusionOur findings highlight the utility of routine non-invasive saliva testing for frontline healthcare workers to protect vulnerable patient populations. A 5-day saliva testing schedule should be considered to help identify silent infections and prevent outbreaks in nursing homes and healthcare facilities.
The impact of vaccination on COVID-19 outbreaks in the United States
Authors: Moghadas Seyed M. , Vilches Thomas N. , Zhang Kevin , Wells Chad R. , Shoukat Affan , Singer Burton H. , Meyers Lauren Ancel , Neuzil Kathleen M. , Langley Joanne M. , Fitzpatrick Meagan C. , Galvani Alison P. 
Published: November 2020

AbstractBackgroundGlobal vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. We evaluated the impact of a 2-dose COVID-19 vaccination campaign on reducing incidence, hospitalizations, and deaths in the United States (US).MethodsWe developed an agent-based model of SARS-CoV-2 transmission and parameterized it with US demographics and age-specific COVID-19 outcomes. Healthcare workers and high-risk individuals were prioritized for vaccination, while children under 18 years of age were not vaccinated. We considered a vaccine efficacy of 95% against disease following 2 doses administered 21 days apart achieving 40% vaccine coverage of the overall population within 284 days. We varied vaccine efficacy against infection, and specified 10% pre-existing population immunity for the base-case scenario. The model was calibrated to an effective reproduction number of 1.2, accounting for current non-pharmaceutical interventions in the US.ResultsVaccination reduced the overall attack rate to 4.6% (95% CrI: 4.3% - 5.0%) from 9.0% (95% CrI: 8.4% - 9.4%) without vaccination, over 300 days. The highest relative reduction (54-62%) was observed among individuals aged 65 and older. Vaccination markedly reduced adverse outcomes, with non-ICU hospitalizations, ICU hospitalizations, and deaths decreasing by 63.5% (95% CrI: 60.3% - 66.7%), 65.6% (95% CrI: 62.2% - 68.6%), and 69.3% (95% CrI: 65.5% - 73.1%), respectively, across the same period.ConclusionsOur results indicate that vaccination can have a substantial impact on mitigating COVID-19 outbreaks, even with limited protection against infection. However, continued compliance with non-pharmaceutical interventions is essential to achieve this impact.Key pointsVaccination with a 95% efficacy against disease could substantially mitigate future attack rates, hospitalizations, and deaths, even if only adults are vaccinated. Non-pharmaceutical interventions remain an important part of outbreak response as vaccines are distributed over time.