bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increase in Detection of Respiratory Syncytial Virus Among Older Adults in Arizona
Authors: Bridge Rebecca , Erhart Laura M. , Brady Shane , Komatsu Kenneth 
Published: February 2021

Objectives Respiratory syncytial virus (RSV) is a common cause of respiratory illness, health care visits, and hospitalizations. Arizona, which began conducting laboratory surveillance in 2004, has noted an increase in RSV cases (defined as a laboratory-positive result) among adults aged ≥65, concurrent with increasing reports from polymerase chain reaction (PCR) testing. We assessed whether the shift in the age distribution of reported RSV cases resulted from a change in RSV testing practices. Methods We used data on laboratory-confirmed RSV cases reported during 2013-2017 from the statewide surveillance system to assess the frequency of test types (rapid antigen, immunofluorescence assay, PCR, and viral culture) by age groups across RSV seasons, and we used logistic regression to estimate changes in odds of receiving a PCR test. We used statewide emergency department hospital discharge data for the same period to assess testing practices regardless of test result. Results The overall proportion of PCR tests among RSV cases increased significantly, from 22% in 2013 to 55% in 2017 ( P < .001). The percentage of RSV cases among adults aged ≥65 also increased significantly, from 4% in 2013 to 11% in 2017 ( P < .001) of RSV cases. Adults aged ≥65 had more than 8 times the odds of positive PCR results than children aged <5, both in crude (odds ratio [OR] = 8.8; 95% CI, 7.6-10.2) and season-adjusted (adjusted OR = 8.1; 95% CI, 7.0-9.5) models. Hospital discharge data corroborated increased RSV PCR usage from 2013 to 2017. Conclusion Increasing RSV rates among adults aged ≥65 are likely a result of changes in testing practices. This age group may need more targeted intervention and future vaccination.
Paroxysmal tonic upgaze accompanied by occipital discharge on electroencephalography: a case report and literature review
Authors: Zhang Yan-Feng , Wang Yi-Zhu , Hao Xiao-Sheng , Zhang Hong-Bo , Wang Jiang-Tao , Liang Jian-Min 
Published: February 2021

Background Paroxysmal tonic upgaze (PTU) is an infantile-onset paroxysmal neurological disorder that is characterized by episodes of sustained conjugate upward eye deviation. The paroxysmal abnormal eye movements need to be differentiated from seizures. We report a case of PTU with occipital discharge on electroencephalography (EEG), which made the diagnosis more complicated. Case presentation A 6-month-old girl presented with paroxysmal upward deviation or left strabismus of the eyes, with a bowed head, lowered jaw, raised eyebrows, closed lips, and slight grin. Each episode lasted for a few seconds, and episodes occurred multiple times per day. EEG showed spike waves in the right occipital region, and the girl was initially misdiagnosed with epilepsy. After further analysis using video EEG, we corrected her diagnosis as PTU and stopped the administration of an antiepileptic drug. Conclusion PTU accompanied by discharge on EEG may lead to a misdiagnosis. Video EEG monitoring, and especially the analysis of EEG traces synchronized with attacks, can provide evidence to distinguish between seizures and non-epileptic events.
Comparative Analysis of Intravenous Pumps Relocation for Critically Ill Isolated COVID-19 Patients From Bedside to Outside the Patient Room
Authors: Shah Ami , Xu Jiashan , Friedman Seana , Puskas John D. , Bhatt Himani V. , Yimen Mekeleya 
Published: February 2021

Objectives: To quantify the impact of IV pump relocation for COVID-19 patients from the bedside to outside the patient room on nurse exposure to COVID-19 and conservation of PPE. Design: Original Article Setting: Intensive care units at a single-center teaching hospital. Patients: Critically ill COVID-19 patients under contact and special droplet precautions. Interventions: Relocation of intravenous pumps for COVID-19 patients from bedside to outside the patient room using extension tubing. Measurements and Main Results: The primary objective of the study was to measure the impact of this strategy on COVID-19 exposure, utilizing the number of nurse entries into the patient room as a surrogate endpoint, and extrapolation of this data to determine the reduction or PPE usage. Secondary endpoints included incidence of extravasation, hyperglycemia, hypotension, and diagnosis of CLABSI/bacteremia. A statistically significant reduction in the primary endpoint of the study was observed as room entries prior to pump relocation averaged 15.36 (± 4.10) as opposed to an average of 7.92 (± 2.19) following pump relocation (p < 0.0001). In both pre- and post-pump relocation groups, there was no incidence of extravasation or CLABSI. No significant differences were noted in number of patients experiencing hyperglycemia, hypotensive episodes, or bacteremia. Conclusions: There was a significant decrease in COVID-19 exposure based on the number of nurse entries following the relocation of intravenous pumps from inside to outside of the patient room. These results may be cautiously extrapolated to suggest a decrease in personal protective equipment utilization. Future prospective, randomized controlled trials investigating the impact of this strategy are required.
Awareness and uptake of pre-exposure prophylaxis for HIV among low-income, HIV-negative heterosexuals in San Francisco
Authors: Namara Daphine , Xie Hui , Miller Desmond , Veloso Danielle , McFarland Willi 
Published: February 2021

We examined pre-exposure prophylaxis (PrEP) awareness and uptake among low-income heterosexual men and women in San Francisco in 2019. Of 294 HIV-negative survey participants, 42.5% were aware of PrEP. Few women (12.5%) and men (8.9%) had discussed PrEP with a healthcare provider; 3.8% of women and 0% of men had used PrEP in the last year. White participants (adjusted odds ratio (aOR) 5.39, 95% CI 1.02, 28.56), women (aOR 2.19, 95% CI 1.30, 3.70), and age 60 years or above (aOR 4.00, 95% CI 1.12, 14.34) had greater odds of being aware of PrEP. Testing for HIV or sexually transmitted infection in the past year was marginally associated with a greater PrEP awareness. Our findings reveal gaps in PrEP implementation associated with social disparities among low-income heterosexuals. Testing services and targeted promotional and educational materials are needed lest high-risk, low-income populations are left behind in San Francisco’s aggressive “Getting to Zero” efforts.
Clascoterone: A Novel Topical Androgen Receptor Inhibitor for the Treatment of Acne
Authors: Kalabalik-Hoganson Julie , Frey Kathleen M. , Ozdener-Poyraz Ayse Elif , Slugocki Malgorzata 
Published: February 2021

Objective: To review the efficacy and safety of clascoterone 1% cream for the treatment of acne vulgaris in patients 12 years of age and older. Data Sources: A literature search through PubMed, MEDLINE, and ClinicalTrials.gov was conducted using the following keywords: clascoterone, cream, acne, and CB-03-01. Articles published between 2004 and 2020 were included in this review. Study Selection and Data Extraction: Preclinical and clinical studies describing the efficacy and safety of topical clascoterone cream were included. Data Synthesis: Early preclinical studies demonstrated that clascoterone exhibits local antiandrogenic effects without any systemic effects. Phase 2 and 3 trials demonstrated a statistically significant reduction in inflammatory and noninflammatory lesions and mild erythema with clascoterone use. Long-term studies confirmed the favorable safety profile of the drug in subjects for up to 9 months of use, with erythema being the most common treatment-emergent local skin reaction. Relevance to Patient Care and Clinical Practice: Pharmacological treatment options for acne vulgaris include topical and systemic agents. Systemic antiandrogen medications are associated with adverse effects and should be avoided in pregnancy and male patients. Clascoterone is a novel topical antiandrogen drug with no systemic adverse effects. This drug provides prescribers with an appealing treatment option for male and female patients 12 years of age and older, who are not candidates for systemic drugs because of contraindications or adverse effects or who have failed other topical therapies. Conclusion: Clascoterone, a novel topical androgen receptor inhibitor, is a safe and effective treatment option for patients with acne vulgaris.
Patterns of Pediatric Facial Fractures
Authors: Hong Kevin , Jeong James , Susson Yehudah N. , Abramowicz Shelly 
Published: February 2021

Objective: The aim of this study was to assess patterns of maxillofacial trauma in the pediatric population in Atlanta. This information is important to help guide management and allocate resources for treatment of maxillofacial injuries at Children’s Healthcare of Atlanta (CHOA). Methods: This study was a retrospective chart review of children who presented from 2006 to 2015. Inclusion criteria were: (1) age 18 years old or younger, (2) presentation to emergency department, (3) diagnosis of maxillofacial fractures, and (4) evaluation by Oral and Maxillofacial Surgery, Otolaryngology, or Plastic Surgery services. Medical records were reviewed to record demographic, mechanism of injury, fracture location, and yearly incidence of injury. Descriptive statistics were computed to summarize findings and overall trends. Results: During the study period, 39,833 patients were identified. Of them, 1995 met the inclusion criteria. The majority were male (n = 1359, 68%) with an average age of 9.4 years old (range of 1 month to 18 years old). Mechanisms of injury were motor vehicle collisions (MVC) (n = 597, 29.9%), fall (n = 565, 28.3%), sports injury (n = 317, 15.9%), pedestrian struck (n = 215, 10.8%), assault/abuse (n = 204, 10.2%), other (n = 81, 4.1%), or gunshot wound (n = 16, 0.8%). Fracture sites were mandible (n = 519, 26%), complex (n = 479, 24%), nasal (n = 419, 21%), dentoalveolar (n = 279, 14%), orbital (n = 259, 13%), and maxilla (n = 40, 2%). Males had a higher incidence of assault than females (n = 185, 91% of assaults). The incidence of maxillofacial trauma increased with age with a peak incidence in 13 to 16-year-olds (n = 566, 28.3%). During the years examined, there was an upward trend in MVCs as the etiology with a peak incidence of facial fractures due to MVCs occurring in 2015. All other mechanisms remained constant during this time period. Conclusions: There was an increase in pediatric facial fractures secondary to motor vehicle collisions from 2007 to 2015 despite improvements in regulations, traffic safety, and technology.
Adapting Nephrology Training Curriculum in the Era of COVID-19
Authors: Cunningham Amanda , Hung Wayne , Levin Adeera , Jamal Abeed 
Published: February 2021

Purpose of review: The COVID-19 pandemic has widespread implications not only for clinical practice but also for academic medicine and postgraduate training. The need to promote physical distancing and flexibility within our department has generated important revisions to the core curriculum for the Adult Nephrology Training Program in Vancouver, Canada. Sources of information: We reviewed available educational resources and objectives to develop curricular adaptations informed by staff and trainee feedback. Methods: Many facets of the program including clinical rotations, scholarly activities, evaluation, and wellness have been impacted, and thus revised for online delivery where possible. Trainees have personalized a learning plan based on individual goals and supplemented by a list of internet-based resources for independent review. Changes in learning objectives and methods for specific rotations have occurred and are described. Ongoing evaluation will be undertaken. Key findings: Curriculum adaptation in the era of COVID-19 is necessary to ensure ongoing high-quality education for future nephrologists. We describe existing changes to formal training in British Columbia (BC), which will be tailored as the pandemic evolves, and anticipate them to have lasting impact on the way we structure training programs in the future. Standardization and harmonization of modified curriculum may be possible across Canada with sharing of these learnings. Limitations: Formal evaluation of these changes in terms of knowledge acquisition and examination performance has not yet been undertaken. Next steps will include assessing and documenting the impact of this curricular transformation to further optimize scheduling, educational yield, and trainee wellness.
Alemtuzumab Versus Anti-Thymocyte Globulin As Conditioning Method for Allogenic Hematopoietic Stem Cell Transplant; A Meta-Analysis
Authors: Poonsombudlert Kittika , Kewcharoen Jakrin , Prueksapraopong Chattip , Nath Limpruttidham 
Published: February 2021

Objective: Anti-thymocyte Globulin (ATG) and Alemtuzumab (Ale) are common methods for T cell depletion in the setting of allogenic hematopoietic stem cell transplant. They are both used to promote engraftment and prevent graft-versus-host disease (GVHD). Currently, there's no comparative meta-analysis for safety and efficacy of Ale versus ATG. Therefore, we conducted a meta-analysis to compare the risk of acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), odd of relapse and overall survival (OS) between Ale and ATG.
Method: We performed a comprehensive literature search in MEDLINE (Pubmed), Cochrane library and EMBASE database from inception to April 2020 for studies that compared the use of Ale and ATG. We conducted a random effect meta-analysis of 11 studies involving a total of 4,239 participants (Ale=1,293, ATG=2,946) and reported the pooled odd ratio (OR) for development of aGVHD, cGVHD, relapse and OS.
Result: We found a significant decreased in odd of aGVHD and cGVHD in the Ale group compared to the ATG group (pooled OR 0.44, 95% CI 0.32-0.61, I2=56.1% and 0.58, 95% CI 0.44-0.77, I2=47.5% respectively) but there were no statistically significant increase in the odd of relapse and OS (pooled OR 1.14, 95% CI 0.81-1.59, I2=64.5% and 1.20, 95% CI 0.83-1.72, I2=76.3% respectively).
Conclusion: There is significantly decreased odd of aGVHD and cGVHD with use of Ale compared to ATG, but there is no statistically significant increased odd of relapse or OS. We concluded that Ale could be the superior method of T cell depletion in terms of decreased aGVHD and cGVHD but there's no significant difference in odd of relapse and OS.

Disclosures
No relevant conflicts of interest to declare.
The Impact of Chromothripsis on the Clinical Outcomes of Acute Myeloid Leukemia (AML): A Meta-Analysis
Authors: Haddad Philip A , Hammoud Dalia , Gallagher Kevin M. 
Published: February 2021

Introduction: Chromothripsis is a single genomic catastrophic event that can involve one or several chromosomes resulting in chromosomal fragmentation. Genomic instability leading to loss of chromosomes and complex karyotype is known to be associated with resistance to chemotherapy and poor prognosis in AML. While chromothripsis is associated with aggressive clinical course in various cancers, its impact on AML clinical outcomes has not been consistently conclusive. The purpose of this meta-analysis is to evaluate the pooled effect of chromothripsis on the response rates and overall survival of patients with AML.
Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of AML diagnosis, English language, and studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves that compared AML outcomes with and without chromothripsis. A meta-analysis using an inverse variance method with a random-effects model was conducted.
Results: Two comparative studies with a total of 444 patients were included in this meta-analysis. In the presence of chromothripsis OS was adversely impacted (HR 1.78, 95%CI: 1.05-3.01, p=0.03) with a heterogeneity estimate, I2=40%. Moreover, response rates were significantly lower in AML cases with chromothripsis versus those without (19% vs. 62%, p&lt;0.05).
Conclusions: This meta-analysis confirms the adverse impact of chromothripsis on response rates and OS of patients with AML.

Disclosures
No relevant conflicts of interest to declare.
Incidence of CDI in a Cohort of US Patients with Newly Diagnosed Acute Myeloid Leukemia Receiving Intensive Chemotherapy
Authors: Lurienne Lise , Le Bescop Clément , Buffet Renaud , Bandinelli Pierre-Alain 
Published: February 2021

Background: The immunosuppression seen in Acute Myeloid Leukemia (AML) patients due to the intensive chemotherapy and consolidation therapies used to treat them is often associated with prolonged episodes of neutropenia. This immediately triggers the use of broad-spectrum antibiotics leading to a profound disruption of the gut microbiota that can persist for months. This dysbiosis increases the risk of Clostridioides difficile infection (CDI), the most common cause of healthcare associated infectious diarrhea.
Aim: The objective of the present study was to assess the anticipated incidence of CDI in patients newly diagnosed with AML and receiving intensive chemotherapies.
Methods: A retrospective analysis was conducted using databases of Truven Health Analytics®. Comprehensive hospitalization data of US patients undergoing induction chemotherapy due to AML were analyzed to detect the incidence of CDI during or after the hospitalization with induction chemotherapy. C. difficile infections were detected through the use of the corresponding 008.45 (ICD-9-CM) or A04.7 (ICD-10-CM) codes in the diagnoses reported in the database records.
Findings: Out of the 81,033 patients diagnosed with hematologic diseases between January 2014 and December 2017 found in the dataset, 1,092 patients were included in the study. The incidence of CDI in the 180 days prior to hospitalization was 0.6%. The in-hospital incidence of CDI was 5.4% and increased to 11.9% at 120 days and 16.1% at 1 year after the start of the intensive chemotherapy.
Conclusions: CDI frequently complicates the care of patients with AML during and after the induction chemotherapy and is to be monitored closely in hospital wards managing patients with hematologic diseases.

Disclosures
Lurienne: Da Volterra: Ended employment in the past 24 months. Le Bescop:Da Volterra: Current Employment. Buffet:Da Volterra: Current Employment; Alfa Collaborative Group: Current Employment. Bandinelli:Da Volterra: Current Employment, Current equity holder in private company.
Allogeneic Hematopoietic Stem Cell Transplantation Overcomes the Poor Prognosis in MLL-Rearranged Solid Tumor Therapy Related-Acute Myeloid Leukemia
Authors: Qi Hanzhou , Jin Hua , Liu Qifa 
Published: February 2021

BACKGROUND: MLL rearrangement is very common in solid tumor therapy-related acute myeloid leukemia (t-AML). This study investigated the prognosis of MLL t-AML.
METHODS: Patients with solid tumor t-AML and MLL de novo AML were enrolled in this retrospective study. The patients were divided into 3 groups: non-MLL t-AML(n=41), MLL t-AML(n=18) and MLL de novo AML(n=98).
RESULTS: Of the 157 patients enrolled, 150 patients underwent anti-leukemia therapy. The complete remission (CR) rate was 83.3%, 85.5% and 86.2%(P=0.251), respectively, in MLL t-AML, non-MLL t-AML and MLL AML groups. The 3-years overall survival (OS) was 37.5%, 21.5% and 20.4% (P=0.046). The 3-years leukemia-free survival (LFS) was 28.0%, 32.2% and 22.7% (P=0.031), and the incidence of relapse was 30.0%, 50.4% and 53.5% (P=0.382), respectively, in the three groups. Multivariate analysis revealed that MLL t-AML was a risk factor while allo-HSCT a protective factor for relapse, LFS, and OS (P=0.005, P&lt;0.001 and P&lt;0.001) (P&lt;0.001, P&lt;0.001 and P=0.002, respectively). The 3-years OS was 0%, 17.9% and 0%(P=0.038), LFS was 0%, 23.1% and 0%(P=0.017), and relapse was 100%, 53.1% and 74.4% (P=0.001), respectively among three groups in patients undergoing chemotherapy alone, while OS was 64.3%, 52.7% and 40.7% (P=0.713), LFS was 60.0%, 48.8% and 37.0% (P=0.934), and relapse was 25.0%, 47.4% and 47.5% (P=0.872), respectively, among these group in the patients undergoing allo-HSCT. Intriguingly, MLL t-AML was no longer risk factor for relapse and LFS (P=0.882 and P=0.484, respectively), while it became a favorable factor for OS (P=0.011) in the patients undergoing allo-HSCT
CONCLUSIONS: MLL t-AML had poor prognosis compared with non-MLL t-AML and MLL de novo AML,, but allo-HSCT might overcome the poor prognosis of MLL t-AML.

Disclosures
Liu: Nanfang Hospital, Southern Medical University: Research Funding.
Observations of PET Scan Levels of Standard Uptake Values (SUV) in Low Grade Follicular Lymphoma (LGFL) with High Proliferation Index (HPI)
Authors: Aldyab Mahmoud , Shiekhmohammed Mohammed 
Published: February 2021

Introduction: Low grade follicular lymphoma (LGFL) with high proliferation index (HPI) behave more like high grade follicular lymphoma (HGFL) and therefore, may require different therapeutic options. Currently they're only identified histologically.
We studied the PET scan observations of this subset of follicular lymphoma (FL) which occupy a clinical grey zone between LGFL and HGFL to determine whether these lymphomas can be distinguished based on PET scan SUV.
Methods: One hundred and twenty-four FL cases at the pathology department at Albany Medical Center between years 2013-2019 were collected. The grade, evaluated based upon the WHO criteria for grading of FL, and KI67 index were recorded. PET scan reports of these cases were reviewed. Cases with no PET scan report, or where the PET scan report did not match the date criteria or site of the biopsy (Bx) were excluded. Of the 87 cases that were included 67 cases were of low grade and 20 cases were of high grade. Among the low grade cases, 23 cases had a high proliferation index (KI67&gt;40%).
53 cases were excisional Bx and 34 Core Bx. The male to female ratio was: 46:40, and the age ranged from 35-92 with a mean of 63.59.
Results: KI67 and SUV means were compared using an independent sample t test and the analysis (table 1) shows that although PET SUV may differentiate HGFL from LGFL, it does not differentiate HGFL from LGFL with HPI when using KI67≥40 % or KI67≥30% as cutoff points.
However, the statistical significance noted in SUV between HGFL and LGFL with HPI when using KI67≥20% as a cut off point, is probably due to the grade of lymphoma, given the loss of significance (p&gt;0.05) when LGFL with KI67≥20% is compared to LGFL with KI67≤20%.
Conclusion: Our findings indicate that LGFL with HPI cannot be reliably identified on PET scan alone. Histology remains the gold standard for identifying low grade follicular lymphoma with high proliferation index.

Disclosures
No relevant conflicts of interest to declare.