bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incomplete abortion with elevated beta-human chorionic gonadotropin levels mimicking a molar pregnancy
Authors: Li Pei-Chen , Chang Kai-Hung , Ding Dah-Ching 
Published: September 2021

Abstract

Rationale:
Incomplete abortion often causes a lot of bleeding and may lead to severe anemia. The elevated beta-human chorionic gonadotropin (beta-hCG) level is often associated with a molar pregnancy. We report a case of incomplete abortion with elevated beta-hCG levels mimicking a molar pregnancy.

Patient concerns:
A 29-year-old woman experienced prolonged vaginal bleeding for several months. She had an artificial abortion one year before, however, vaginal bleeding was noted, and the local clinic prescribed progesterone and transamine to stop the bleeding. The amount of bleeding decreased after medication, but persistent bleeding was noted.

Diagnosis:
She visited our hospital where the urine pregnancy test was positive. Ultrasound and computed tomography showed a hematometra (4.5 cm × 4.3 cm), thickened endometrium, and mild ascites. An elevated serum beta-hCG level of 32980.4 mIU/mL was observed along with a hemoglobin level of 7.2 g/dL. Incomplete abortion or molar pregnancy was suspected.

Interventions:
Endometrial curettage was performed.

Outcomes:
Pathology showed the gestational product and chromosome analysis showed normal karyotyping. Incomplete abortion was diagnosed. Postoperative follow-up was uneventful and the beta-hCG level returned to normal after 3 months.

Lessons:
Incomplete abortion with elevated beta-hCG levels is a rare condition that mimics a molar pregnancy. Transvaginal ultrasound, quantitative serum hCG evaluation, and other laboratory tests (e.g., complete blood count) are essential preoperative investigations.
A case report of IgG4-related kidney disease with cirrhosis as the first manifestation
Authors: Wan Hongpin , Fang Zheng , Li Zhen , Luo Min , Zhang Jianbin 
Published: September 2021

Abstract

Introduction:
Immunoglobulin G4-related kidney disease (IgG4-RKD) is a recently identified inflammatory disorder most often classified as IgG4-related tubulointerstitial nephritis or IgG4-related membranous nephropathy based on the predominant renal pathology. However, almost all the cases are complicated by extrarenal organ involvement that includes lymph nodes, pancreas, lacrimal glands, salivary glands, and/or retroperitoneum. IgG4-RKD with cirrhosis as the initial presentation followed by massive proteinuria and renal dysfunction is very rare.

Patient concerns:
A 35-year-old Chinese male presented to a local hospital with abdominal distension, edema, and black tarry stool 5 years before. Abdominal color ultrasonography at that time suggested cirrhosis, and the diagnosis was upper gastrointestinal hemorrhage with decompensated cirrhosis. About two weeks before, edema was aggravated, and massive proteinuria and renal impairment were detected with significantly elevated serum IgG. Abdominal computed tomography indicated cirrhosis and diffuse renal enlargement with multiple low-density foci, while light microscopy of renal biopsy tissue indicated atypical membranous nephropathy with interstitial nephritis. Immunohistochemistry revealed 20–50 IgG-positive plasma cells per high-power field among interstitial infiltrating cells, accounting for ∼40% of all IgG-positive plasma cells.

Diagnoses:
According to clinical manifestations and immunohistochemical findings, the diagnosis was IgG4-RD/IgG4-RKD featuring atypical membranous nephropathy, interstitial nephritis, and decompensated cirrhosis.

Interventions:
Methylprednisolone 40 mg/day was administered for IgG4 related kidney disease. Other symptomatic therapies were also administered.

Outcomes:
Half a month following the treatment, 24-hour proteinuria decreased from 10.67 g/d to 2.16 g/d and serum creatinine decreased significantly.

Conclusion:
IgG4-RKD with cirrhosis as the first manifestation followed by renal dysfunction is very rare. Simultaneous occurrence of these two conditions which improved after the treatment indicates that there may be an association between IgG4 related kidney disease and cirrhosis.
Better outcomes for everybody evaluates the effectiveness and cost-effectiveness of a pharmacist-led intervention, delivered by community pharmacists in collaboration with physicians, in improving disease control, compared with usual care, in asthma and COPD patients during and after COVID-19
Authors: Manfrin Andrea , Jackson Catherine , Campisi Raffaele , Oteri Alessandro , Copani Agata , Desideri Enrico , Tsiachristas Apostolos , Candio Paolo , Di Tomaso Giulia , Vitale Maria , Crimi Nunzio 
Published: September 2021

Abstract

Introduction:
In 2025, more than 400 million people will have asthma, and chronic obstructive pulmonary disease (COPD) will be the third leading cause of death by 2030. This trial, called better outcomes for everybody, will evaluate the effectiveness and cost-effectiveness of a pharmacist-led intervention delivered by community pharmacists in collaboration with physicians to asthma and COPD patients to improve disease control compared with usual care.

Methods:
A pragmatic parallel 2-arm randomized controlled trial will be conducted in one Italian region (Sicily). A 2:1 randomization and sample size of 900 adult patients (450 with asthma, 450 with COPD) will be sufficient to detect a difference of 15% between the intervention and control groups using a dichotomized score (controlled versus non-controlled) of the Asthma Control Test (ACT) and the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ) with a two-tails, 99% power and 5% significance level. A hundred pharmacists will recruit 9 consecutive patients each and administer either ACT or CCQ according to the patients’ disease. Patients will be followed up for 12 months, and the pharmacists will meet their patients every three months. The control group will receive usual care, the intervention a bespoke, structured, and systematic consultation immediately after baseline and 6 months later. The primary outcomes are asthma and COPD control at baseline and 12 months. Secondary outcomes: risk of uncontrolled asthma and COPD, number of active ingredients, pharmaceutical care issues, adherence to medications, minimal clinically important differences in asthma and COPD, and a full health economic evaluation. The analysis will follow an intention-to-treat principle. Generalized estimating equations will be used to test the primary outcomes. Ethics approval was obtained.

Discussion:
This is the first study conducted in Italy to assess the effectiveness and cost-effectiveness of a pharmacist-led intervention in asthma and COPD patients at the same time. This research could introduce a new model of care that can be adapted to other chronic conditions in primary care settings. The results will be disseminated to service users and their families via media, healthcare professionals via professional training and meetings, and researchers via conferences and publications.

Trial registration:
ISRCTN, ID: 38734433 Registered on June 15, 2021
The Effect of Using In Vitro Fertilization (IVF) on Increasing the Prevalence of Craniosynostosis
Authors: Kalantar-Hormozi Abdoljalil , Moradi Ehsan , Hashemi Seyedeh Zohreh , Kalantar-Hormozi Hadis , Abbaszadeh-Kasbi Ali 
Published: September 2021

Background:
Craniosynostosis, a malformation caused by premature closure of one or more cranial sutures, is a rare congenital disability usually of unknown cause; however, it is often associated with assisted reproductive technology. Given the increasing prevalence of craniosynostosis and the use of the in vitro fertilization (IVF) method, the authors evaluated the association between IVF and the prevalence of craniosynostosis.

Methods:
This retrospective study reviewed records of patients with nonsyndromic craniosynostosis who underwent surgery in Mofid Hospital, a tertiary children's hospital affiliated to Shahid Beheshti University of Medical Sciences, between 2010 and 2019.

Results:
A total of 200 patients aged one month to 7 years old, were evaluated. Out of 200 patients, 43% were plagiocephalic, 39% trigonocephalic, 8.5% scaphocephalic, 8% brachiocephalic, and 1.5% were mixed. Nine (4.5%) patients had received clomiphene citrate. Eight (4%) mothers had become pregnant under IVF, and they all had used clomiphene citrate for ovulation stimulation. No use of artificial insemination was reported. Of the eight patients whose mother had become pregnant through IVF, three were trigonocephalic, and five were plagiocephalic.

Conclusions:
Without a control group, we are not able report the statistical results confirming or denying a link between craniosynostosis and infertility treatment. However, 4% prevalence of IVF use among craniosynostosis patients is significant. Further studies with a broader statistical community are suggested in this regard.
Masking significantly reduces, but does not eliminate COVID-19 infection in a spatial agent-based simulation of a University dormitory floor
Authors: McPeck Roxanne , Magori Krisztian 
Published: September 2021

AbstractCOVID-ADAPT is a stochastic, discrete-space, agent-based simulation model of airborne infection and public health interventions, capable of modeling SARS-CoV-2 transmission. Using a map of a real university dormitory floor, the model simulates agents moving about and potentially infecting each other. Health interventions tested are vaccination and masking, including whether the solitary initial infectious agent was masked. Universal masking with N95 masks and 100% vaccination of susceptible people resulted in significantly lower prevalence after 3 weeks compared to all other scenarios, but still led to a substantial number of infections. Increased vaccination levels from 52% to 100% by itself did not result in a significant difference in prevalence due to symptomatic and asymptomatic breakthrough infections. These results suggest that vaccination alone is insufficient to stem outbreaks, and the best way to reduce COVID-19 infections is to ensure that all infectious people are masked. However, because asymptomatic infections are common, the only way to ensure this is universal masking, which also reduces prevalence by protecting susceptible individuals from infection. Universal masking is the best way forward, especially under threat of the Delta variant, to keep facilities open and safe for occupants, while minimizing the number of infections.
PCR test positive rate revealing the real infection epidemic status examined in the COVID-19 epidemic in Tokyo, Japan
Authors: Tomie Toshihisa 
Published: September 2021

AbstractIn order to come up with effective infectious disease countermeasures, we need a method to evaluate the effectiveness of the countermeasures. As the most reliable epidemic diagnosis, we propose the PCR test positive rate. Examining the COVID-19 epidemic in Tokyo shows that the positive rate follows the epidemic accurately, without being affected by medical institution closures or the psychology of people. By comparing with the change of the positive rate, we argue that the psychology of people was the cause of the observed asymmetry and shallow valleys in the number of confirmed cases. We discuss that the positive rate as large as 1-5% in the valleys of the epidemic implies that many people are already infected and immune. The observed fact that the positive rate followed the number of positives accurately and the value lower than those reported in the test-negative design studies of influenza are attributable to the government’s policy of finding as many patients as possible. We mention three possibilities as the causes of the repeated COVID-19 epidemic in Japan.
Self-reported and physiological reactions to the third BNT162b2 mRNA COVID-19 (booster) vaccine dose
Authors: Mofaz Merav , Yechezkel Matan , Guan Grace , Brandeau Margaret L. , Patalon Tal , Gazit Sivan , Yamin Dan , Shmueli Erez 
Published: September 2021

AbstractBackgroundThe rapid rise in hospitalizations associated with the Delta-driven COVID-19 resurgence, and the imminent risk of hospital overcrowding, led the Israeli government to initialize a national third (booster) COVID-19 vaccination campaign in early August 2021, offering the BNT162b2 mRNA vaccine to individuals who received their second dose over five months ago. However, the safety of the third (booster) dose has not been fully established yet.ObjectiveEvaluate the short-term, self-reported and physiological reactions to the third BNT162b2 mRNA COVID-19 (booster) vaccine dose.DesignA prospective observational study, in which participants are equipped with a smartwatch and fill in a daily questionnaire via a dedicated mobile application for a period of 21 days, starting seven days before the vaccination.SettingAn Israel-wide third (booster) vaccination campaign.ParticipantsA group of 1,609 (18+ years of age) recipients of at least one dose of the BNT162b2 vaccine between December 20, 2020, and September 15, 2021, out of a larger cohort of 2,912 prospective study participants. 1,344 of the participants were recipients of the third vaccine dose.MeasurementsDaily self-reported questionnaires regarding local and systemic reactions, mood level, stress level, sport duration, and sleep quality. Heart rate, heart rate variability and blood oxygen saturation level were continuously measured by Garmin Vivosmart 4 smartwatches.ResultsThe extent of systemic reactions reported following the third (booster) dose administration is similar to that reported following the second dose (p-value=0.305) and considerably greater than that reported following the first dose (p-value<0.001). Our analyses of self-reported well-being indicators as well as the objective heart rate and heart rate variability measures recorded by the smartwatches further support this finding. Focusing on the third dose, reactions were more apparent in younger participants (p-value<0.01), in women (p-value<0.001), and in participants with no underlying medical conditions (p-value<0.001). Nevertheless, reported reactions and changes in physiological measures returned to their baseline levels within three days from inoculation with the third dose.LimitationsParticipants may not adequately represent the vaccinated population in Israel and elsewhere.ConclusionOur work further supports the safety of a third COVID-19 BNT162b2 mRNA (booster) vaccine dose from both a subjective and an objective perspective, particularly in individuals 65+ years of age and those with underlying medical conditions.Primary funding sourceEuropean Research Council (ERC) project #949850
Metformin: We need to either put it in our drinking water or rethink how we study it
Authors: Powell Mike , Clark Callahan , Alyakin Anton , Vogelstein Joshua T , Hart Brian 
Published: September 2021

STRUCTURED ABSTRACTObjectivesTo expose the potential impact of residual confounding in common observational study designs investigating metformin using a type 2 diabetes cohort; to propose a more robust study design for future observational studies of metformin.DesignRetrospective cohort studies using a prevalent user design conducted in two distinct cohorts: individuals with type 2 diabetes and individuals with prediabetes.SettingInsurance claims database for Medicare Advantage beneficiaries in the United States, 2018-2019. An identical analysis of commercial insurance beneficiaries appears in the supplement.Participants404,765 individuals with type 2 diabetes, 81,791 individuals with prediabetes.Main outcome measuresTotal inpatient admission days in 2019, total medical spend (excluding prescription drugs) in 2019. Each of these measures is treated as a binary outcome: greater than zero inpatient days and top 10% medical spend.ResultsWe implement a common observational study design and observe a strong metformin effect estimate associated with reduced inpatient admissions and reduced medical expenditures; we also implement a more robust study design that suggests any estimated effect is attributable to residual confounding related to individuals’ overall health.ConclusionsCommon observational study designs examining metformin in a type 2 diabetes population are likely impacted by significant residual confounding. By additionally considering numerous negative control outcomes and a complementary prediabetes cohort, the study design proposed here demonstrates efficacy at exposing residual confounding related to overall health, nullifying the claim derived from a standard study design.Trial registrationPreregistration available at https://osf.io/qf49p.
The Geography of Chronic Pain in the United States and Canada
Authors: Zajacova Anna , Lee Jinhyung , Grol-Prokopczyk Hanna 
Published: September 2021

AbstractOur understanding of population pain epidemiology is largely based on national-level analyses. This focus, however, neglects potential cross-national, and especially sub-national, geographic variations in pain, even though geographic comparisons could shed new light on factors that drive or protect against pain. This article presents the first comparative analysis of pain in the U.S. and Canada, comparing the countries in aggregate and analyzing variation across states and provinces. Analyses are based on cross-sectional data collected in 2020 from 2,124 U.S. and 2,110 Canadian adults 18 years and older. Our pain measure is a product of pain frequency and pain-related interference with daily activities. We use regression and decomposition methods to link socioeconomic characteristics and pain, and inverse-distance weighting spatial interpolation to map pain scores. We find significantly and substantially higher pain in the U.S. than in Canada. The difference is accounted for by Americans’ lower economic wellbeing. Additionally, we find variation in pain within countries; the variation is statistically significant across U.S. states. Further, we identify nine hotspot states in the Deep South, Appalachia, and the West where respondents have significantly higher pain than those in the rest of the U.S. or Canada. This excess pain is partly attributable to economic distress, but a large part remains unexplained; we speculate that it may reflect the sociopolitical context of the hotspot states. Overall, our findings identify areas with high need for pain prevention and management; they also other scholars to consider geographic factors as important contributors to population pain.
Protocol: A two-wave cross-sectional study in England investigating suicidal behaviour and self-harm amongst healthcare workers during the Covid-19 pandemic
Authors: Padmanathan Prianka , Lamb Danielle , Scott Hannah , Wessely Simon , Moran Paul 
Published: September 2021

AbstractIntroductionThere have been longstanding concerns regarding an increased risk of suicide amongst healthcare workers. The Covid-19 pandemic has placed an additional burden on staff, yet few studies have investigated the impact of the pandemic on their risk of suicide and self-harm. We aimed to investigate the cumulative incidence, prevalence, and correlates of suicidal ideation, suicide attempts, and non-suicidal self-injury amongst healthcare workers during the Covid-19 pandemic.Methods and AnalysisNHS Check is an online survey that was distributed to all staff (clinical and non-clinical), students, and volunteers in 18 NHS Trusts across England during the Covid-19 pandemic. Data collected in wave 1 (collected between April 2020 and January 2021) and wave 2 (collected 6 months after wave 1) will be analysed. The full cohort of wave 1 participants will be weighted to represent the age, sex, ethnicity, and roles profile of the workforce at each Trust, and the weighted prevalence and cumulative incidence of suicidal ideation, suicide attempts, and non-suicidal self-injury will be described. Two-level random effects logistic regression models will be used to investigate the relationship between suicidal behaviour and self-harm, and demographic characteristics (age, sex, ethnicity) and workplace factors (concerns regarding access to personal protective equipment, re-deployment status, moral injury, confidence around raising and the management of safety concerns, support by supervisors or managers, satisfaction with standard of care provided). Results will be stratified by role (clinical/non-clinical).Changes in this protocol compared with the original versionAll variables describing workplace factors will be analysed as binary variables for consistency.The responses to two questions on raising, and the management of, safety concerns will be analysed separately rather than combined to minimise loss of information.Binary suicide-related outcomes will be used in the logistic regression analyses, where the presence of an outcome represents its occurrence within the previous one (wave 2) or two months (wave 1), specifically. This was previously not specified.
The longitudinal kinetics of antibodies in COVID-19 recovered patients over 14 months
Authors: Eyran T. , Vaisman-Mentesh A. , Dror Y. , Aizik L. , Kigel A. , Rosenstein S. , Bahar Y. , Taussig D. , Tur-Kaspa R. , Kournos T. , Markovitch D. , Dicker D. , Wine Y. 
Published: September 2021

SummaryHere, we describe the longitudinal kinetics of the serological response in COVID-19 recovered patients over the period of 14 months. The antibody kinetics in a cohort of 200 recovered patients with 89 follow up samples at 2-4 visits reveal that RBD-specific antibodies decay over the period of 14 month following the onset of symptoms. The decay rate is associated with the robustness of the response thus, recovered patients that exhibit elevated antibody levels at the first visit, experience faster decay. We further explored the longitudinal kinetics differences between recovered patients and naïve BNT162b2 vaccinees. We found a significantly faster decay in naïve vaccinees compared to recovered patients suggesting that the serological memory following natural infection is more robust compared to vaccination. Our data highlights the differences between serological memory induced by natural infection vs. vaccination, facilitating the decision making in Israel regarding the 3rd dose vaccination.
Association of Vaccine Uptake and COVID-19 Infections among nursing home staff and residents in Missouri, United States
Authors: Scroggins Stephen , Ellis Matthew , Shacham Enbal 
Published: September 2021

AbstractNursing homes (NH) continue to struggle with COVID-19 morbidity and mortality with older adult residents at greater risk of infection due to proximity to other residents, advanced aging-related chronic illnesses, and contact with staff. While many states have prioritized COVID-19 vaccinations among older adults, vaccinations among NH staff vary. The purpose of this study was to quantify the relationship between nursing home staff vaccination uptake and COVID-19 infections among residents. A zero-inflated Poisson regression model was constructed to predict the weekly number of COVID-19 cases among Missouri nursing home residents using data from the Centers for Medicaid and Medicare Services. A total of 1,124 COVID-19 infections were reported among 504 NH residents between January 1, 2021 and August 22, 2021. After adjusting for number of total residents, resident vaccine rate, staff quality rating, and respective county COVID-19 rate, for every percent increase in nursing home staff vaccine rate the risk of COVID-19 infections significantly decreased by 13% (IRR 0.87, 95% CI 0.81, 0.93). This study identified that NH staff, likely due to greater mobility, are important to prioritize in vaccination efforts to protect themselves and residents of their facilities from COVID-19 infections. Further, the CMS staff ratings were significant predictors of infection as well, which highlight the structural challenges that exist within and outside the context of a highly infectious and deadly pandemic. These results also provide insights to optimizing vaccination roll-out to best protect our communities’ most vulnerable residents.