bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of Covid-19 isolation measures on the cognition and mental health of people living with dementia: a rapid systematic review of one year of evidence
Authors: Suárez-González Aida , Rajagopalan Jayeeta , Livingston Gill , Alladi Suvarna 
Published: March 2021

AbstractBackgroundCovid-19 control policies have entailed lockdowns and confinement. Although these isolation measures are thought to be particularly hard and possibly harmful to people with dementia, their specific impact during the pandemic has not yet been synthesised. We aimed to examine and summarise the global research evidence describing the effect of Covid-19 isolation measures on the health of people living with dementia.MethodWe searched Pubmed, PsycINFO and CINAHL up to February 2021 for peer-reviewed quantitative studies of the effects of isolation measures during Covid-19 on cognitive, psychological and functional symptoms of people with any kind of dementia or mild cognitive impairment. We summarised the findings of included papers following current guidelines for rapid reviews.ResultsWe identified 15 eligible papers, examining a total of 6,442 people with dementia. 13/15 were conducted in people living in the community and 2 in care homes. 60% (9/15) studies reported changes in cognition with 77% (7/9) of them describing declined cognition by >50% of respondents. 93% (14/15) of studies reported worsening or new onset of behavioural and psychological symptoms. 46% (7/15) studies reported changes in daily function, 6 of them reporting a functional decline in a variable proportion of the population studied.ConclusionLockdowns and confinement measures brought about by the pandemic have damaged the cognitive and psychological health and functional abilities of people with dementia across the world. It is urgent that infection control measures applied to people with dementia are balanced against the principles of non-maleficence. This systematic review makes 4 specific calls for action.Key PointsNeuropsychiatric symptoms of people with dementia (e.g., anxiety, depressive symptoms, apathy, agitation) were found to worsen during lockdown in the majority of studies.Cognitive decline affecting memory, orientation concentration and communication was observed by caregivers within few weeks after lockdown.The deterioration reported occurred in a short window of time (between 1 and 4 months) and it is unlikely to be attributable to the natural variation of the course of dementia.There is little research conducted in care home residents with dementia (only 2 papers found).Increase consumption of antipsychotics and benzodiazepines has occurred in people with dementia during lockdown.Evidence indicates that isolation measures quickly damaged people’s with dementia cognitive and mental health and probably accelerated overall decline.
Compliance to 4Ds of antimicrobial stewardship practices in a tertiary care centre
Authors: Dixit Diksha , Ranka Rajat , Panda Prasan Kumar 
Published: March 2021

AbstractBackgroundIndiscriminate use of antimicrobials has been a cause of concern worldwide in recent years because of the potential to give rise to antimicrobial resistance and difficult to treat infections. Antimicrobial Stewardship describes the practice of promoting the selection of the right drug, dosage, delivery route, and duration of antimicrobial therapy (4Ds) to curtail these concerns. Nevertheless, it is important to quantify the magnitude of the problem in terms of the percentage of adherence with respect to each of the 4Ds described above. This will aid in the identification of areas for potential interventions to improve use.MethodsWe undertook a prospective review of the medical records of patients admitted in the medicine wards of a tertiary care centre in Northern India. All those patients who were prescribed on antimicrobials were included and their records reviewed for the indication, drug, dose, delivery, and duration (or by asking the treating physician if not documented). Adherence to the guidelines was determined by referring to the updated literature (local, national, or international standard treatment guidelines or textbooks) for each specific disease condition.ResultsOf the total 304 patients, the choice of drugs was appropriate and matched the guidelines in 218 (72%) patients. Adherence to the right dose in 210 (69%), route of delivery in 216 (71%), and to duration in 197 (65%) were observed. Full adherence to all the above mentioned parameters was observed in 196 (64.5%). Maximum adherence was observed in the treatment of skin and soft tissue infections (100 %) while minimum adherence was observed while administering medical prophylaxis (40 %). Among the non-adherents, over-prescription was observed in 10 (3.3 %), under-prescription in 12 (3.9 %), choice was inappropriate in 46 (15.1 %) and in 30 (10 %) patients, antimicrobials were not indicated but prescribed.ConclusionInternist practices antimicrobial stewardship with respect to the prevalent guidelines for right prescription in 2/3rd admitted patients, a sub-optimal one. Right drug, dose, delivery route, duration of therapy are practiced in 72%, 69%, 71%, and 65% patients respectively. To increase adherence to 100%, bedside stewardship practices in form of prospective audit and feedback must be improved.
ExPheWas: a browser for gene-based pheWAS associations
Authors: Legault Marc-André , Perreault Louis-Philippe Lemieux , Dubé Marie-Pierre 
Published: March 2021

Structured AbstractMotivationThe relationship between protein coding genes and phenotypes has the potential to inform on the underlying molecular function in disease etiology. We conducted a phenome-wide association study (pheWAS) of protein coding genes using a principal components analysis-based approach in the UK Biobank.ResultsWe tested the association between 19,114 protein coding gene regions and 1,210 phenotypes including anthropometric measurements, laboratory biomarkers, cancer registry data, hospitalization and death record codes and algorithmically-defined cardiovascular outcomes. We report the pheWAS results in a user-friendly web-based browser. Taking atrial fibrillation, a common cardiac arrhythmia, as an example, ExPheWas identified genes that are known drug targets for the treatment of arrhythmias and genes involved in biological processes implicated in cardiac muscle function. We also identifiedMYOTas a possible atrial fibrillation gene.Availability and implementationThe ExPheWas browser and API are available athttp://exphewas.statgen.org/ContactMarie-Pierre.Dube@mhi-rc.org
Modelling the impact of rapid tests, tracing and distancing in lower-income countries suggest that optimal policies vary with rural-urban settings
Authors: Jiang Xilin , Gong Wenfeng , Dobreva Zlatina , Gao Ya , Quaife Matthew , Fraser Christophe , Holmes Chris 
Published: March 2021

AbstractLow- and middle-income countries (LMICs) remain of high potential for hotspots for COVID-19 deaths and emerging variants given the inequality of vaccine distribution and their vulnerable healthcare systems. We aim to evaluate containment strategies that are sustainable and effective for LMICs. We constructed synthetic populations with varying contact and household structures to capture LMIC demographic characteristics that vary across communities. Using an agent- based model, we explored the optimal containment strategies for rural and urban communities by designing and simulating setting-specific strategies that deploy rapid diagnostic tests, symptom screening, contact tracing and physical distancing. In low-density rural communities, we found implementing either high quality (sensitivity > 50%) antigen rapid diagnostic tests or moderate physical distancing could contain the transmission. In urban communities, we demonstrated that both physical distancing and case finding are essential for containing COVID-19 (average infection rate < 10%). In high density communities that resemble slums and squatter settlements, physical distancing is less effective compared to rural and urban communities. Lastly, we demonstrated contact tracing is essential for effective containment. Our findings suggested that rapid diagnostic tests could be prioritised for control and monitor COVID-19 transmission and highlighted that contact survey data could guide strategy design to save resources for LMICs. An accompanying open source R package is available for simulating COVID-19 transmission based on contact network models.
Hospitalization of mild cases of community-acquired pneumonia decreased more than severe ones during the COVID-19 epidemic
Authors: Nagano Hiroyuki , Takada Daisuke , Shin Jung-ho , Morishita Tetsuji , Kunisawa Susumu , Imanaka Yuichi 
Published: March 2021

AbstractObjectiveThe epidemic of the coronavirus disease 2019 (COVID-19) has affected the entire health care systems. Our aim was to assess the impact of the COVID-19 epidemic on the number and severity of cases for community-acquired pneumonia (CAP) in Japan.MethodsUsing claims data from the Quality Indicator/Improvement Project (QIP) database, we included urgent cases of inpatients for CAP from August 1, 2018, to July 30, 2020. We compared the monthly ratio of inpatient cases from August 2018 to July 2019 and August 2019 to July 2020 as a year-over-year comparison. We also compared this ratio according to the severity score “A-DROP” and performed an interrupted time series analysis (ITS) to evaluate the impact of the COVID-19 epidemic on the monthly number of inpatient cases.ResultsA total of 67,900 inpatient cases for CAP in 262 hospitals were included. During the COVID-19 epidemic (defined as the period between March and July 2020), the number of inpatient cases for CAP drastically decreased during the epidemic compared with the same period in the past year (−48.1%), despite only a temporary reduction in the number of other urgent admissions. The number of inpatient cases decreased according to the severity of pneumonia. Milder cases showed a greater decrease in the year-over-year ratio than severe ones (mild −55.2%, moderate −45.8%, severe −39.4%, and extremely severe − 33.2%). The ITS analysis showed that the COVID-19 epidemic reduced the monthly number of inpatient cases for CAP significantly (estimated decrease: −1233 cases; 95% CI, −521 to −1955).ConclusionsOur study showed a significant reduction in the number of inpatient cases for CAP during the COVID-19 epidemic in Japan. The milder cases showed a greater decrease in the year-over-year ratio of the number of inpatient cases.
Generation of Inhibitory Autoantibodies to ADAMTS13 in Coronavirus Disease 2019
Authors: Doevelaar Adrian A. N. , Bachmann Martin , Hölzer Bodo , Seibert Felix S. , Rohn Benjamin J. , Witzke Oliver , Dittmer Ulf , Brenner Thorsten , Paniskaki Krystallenia , Yilmaz Serap , Dittmer Rita , Schneppenheim Sonja , Babel Nina , Budde Ulrich , Westhoff Timm H. 
Published: March 2021

AbstractObjectivesIt has recently been shown that von Willebrand factor (vWf) multimers may be a key driver of immunothrombosis in Coronavirus disease 2019 (COVID-19). Since COVID-19 is associated with an increased risk of autoreactivity, the present study investigates, whether the generation of autoantibodies to ADAMTS13 contributes to this finding.DesignObservational prospective controlled multicenter study.SettingBlood samples and clinical data of patients with COVID-19 were collected regularly during hospitalization in the period from April to November 2020.Patients90 patients with confirmed COVID-19 of mild to critical severity and 30 healthy controls participated in this study.Measuerements and Main ResultsAntibodies to ADAMTS13 occurred in 31 (34.4%) patients with COVID-19. Generation of ADAMTS13 antibodies was associated with a significantly lower ADAMTS13 activity (56.5%, interquartile range (IQR) 21.25 vs. 71.5%, IQR 24.25, p=0.0041), increased disease severity (severe or critical disease in 90% vs. 62.3%, p=0.0189), and a trend to a higher mortality (35.5% vs. 18.6%, p=0.0773). Median time to antibody development was 11 days after first positive SARS-CoV-2-PCR specimen.ConclusionThe present study demonstrates for the first time, that generation of antibodies to ADAMTS13 is a frequent finding in COVID-19. Generation of these antibodies is associated with a lower ADAMTS13 activity and an increased risk of an adverse course of the disease suggesting an inhibitory effect on the protease. These findings provide a rationale to include ADAMTS13 antibodies in the diagnostic workup of SARS-CoV-2 infections.
Interpregnancy interval and pregnancy loss in a rural South Africa: A population-based cohort study
Authors: Moodley Y. , Herbst Kobus , Tanser F. 
Published: March 2021

ABSTRACTStudy questionWhat is the relationship between interpregnancy interval (IPI) and pregnancy loss in a a rural sub-Saharan African (SSA) setting?Summary answerIPIs >60 months, but not <6 months, were associated with a higher odds of pregnancy loss in our SSA setting.What is known alreadyIPIs >60 months are detrimental to both fetal and maternal health, while contradictory findings exist for IPIs <6 months. No studies have investigated the relationship between IPI and pregnancy loss in SSA settings, despite high pregnancy loss rates and exponential population growth in the SSA region.Study design, size, durationPopulation-based cohort involving 8940 women aged 16-35 years who reported two consecutive singleton pregnancies between 2000 and 2017.Participants/materials, setting, methodsStudy participants were from the uMkhanyakude District in KwaZulu-Natal, South Africa. We obtained data on pregnancy-related characteristics and other variables relevant to pregnancy loss from regular surveys conducted by the Africa Health Research Institute (AHRI) as part of its demographic and health surveillance platform. IPI was determined as the time in months between the end of the first pregnancy and the start of the second pregnancy. Pregnancy loss was defined as either miscarriage or stillbirth. We used an adjusted logistic regression model to investigate the relationship between IPI and pregnancy loss.Main results and the role of chanceIPIs >60 months were associated with an almost three-fold higher odds of pregnancy loss (Adjusted Odds Ratio: 2.64, 95% Confidence Interval:1.71-4.09) when compared with IPIs of 6-60 months. IPIs <6 months conferred a similar odds of pregnancy loss when compared with IPIs of 6-60 months (Adjusted Odds Ratio: 0.82, 95% Confidence Interval: 0.35-1.91).Limitations, reasons for cautionPossible recall bias around some of the pregnancy-related data. Inability to adjust our multivariate statistical analysis for certain sexually transmitted diseases which are known risk factors for pregnancy loss.Wider implications of the findingsFamily planning services in SSA should consider discouraging IPIs >60 months. Although IPIs <6 months had no impact on pregnancy loss, these should also be discouraged in SSA, given the potential socioeconomic consequences for the already vulnerable women of this region.Study funding/competing interest(s)The corresponding author was supported with a postdoctoral fellowship under a National Institute of Health grant (R01 HD084233). The AHRI demographic and health surveillance platform is supported by the Wellcome Trust (201433/Z/16/Z), and the South African Population Research Infrastructure Network. No competing interests are declared.Trial registration numberN/A.
A systematic review of resting state functional MRI connectivity changes and cognitive impairment in multiple sclerosis
Authors: Jandric Danka , Doshi Anisha , Scott Richelle , Paling David , Rog David , Chataway Jeremy , Schoonheim Menno , Parker Geoff , Muhlert Nils 
Published: March 2021

AbstractCognitive impairment is common in multiple sclerosis (MS) and resting state functional MRI (rs-fMRI) functional connectivity (FC) is increasingly used to study its pathophysiology. However, results remain difficult to interpret, showing both high and low FC associated with cognitive impairment. We conducted a systematic review of rs-fMRI studies in MS to understand whether the direction of FC change relates to cognitive dysfunction, and how this may be influenced by the choice of methodology. Embase, Medline and PsycINFO were searched for studies assessing cognitive function and rs-fMRI FC in adults with MS. Fifty-seven studies were included in a narrative synthesis. Of these, 50 found an association between cognitive impairment and FC abnormalities. Worse cognition was linked to high FC in 18 studies, and to low FC in 17 studies. Nine studies found patterns of both high and low FC related to poor cognitive performance, in different regions or for different MR metrics. There was no clear link to increased FC during early stages of MS and reduced FC in later stages, as predicted by common models of MS pathology. Throughout, we found substantial heterogeneity in study methodology, and carefully consider how this may impact on the observed findings. These results indicate an urgent need for greater standardisation in the field – in the choice of MRI analysis and the definition of cognitive impairment. Through this we will be closer to using rs-fMRI FC as a biomarker in clinical studies, and as a tool to understand mechanisms underpinning cognitive symptoms in MS.Key pointsCognitive impairment in multiple sclerosis (MS) is increasingly being researched with advanced magnetic resonance imaging (MRI) measures, including resting state functional MRI (rs-fMRI)The rs-fMRI functional connectivity (FC) metric is associated with cognitive impairment, and has the potential to be a biomarker of cognitive decline.A main challenge to developing a FC biomarker is the lack of consistency in the direction of FC changes associated with cognitive impairment, with cognitive deficits associated with both lower and higher FC.FC changes don’t appear to be linked to clinical and methodological factors such as disease phenotype, disease duration and brain region or network studied.Overall, there is substantial heterogeneity in study methodology, suggesting an acute need to standardise the study of cognitive impairment in MS and its investigation by rs-fMRI methods.
A Prospective Study of Long-Term Outcomes Among Hospitalized COVID-19 Patients with and without Neurological Complications
Authors: Frontera Jennifer A. , Yang Dixon , Lewis Ariane , Patel Palak , Medicherla Chaitanya , Arena Vito , Fang Taolin , Andino Andres , Snyder Thomas , Madhavan Maya , Gratch Daniel , Fuchs Benjamin , Dessy Alexa , Canizares Melanie , Jauregui Ruben , Thomas Betsy , Bauman Kristie , Olivera Anlys , Bhagat Dhristie , Sonson Michael , Park George , Stainman Rebecca , Sunwoo Brian , Talmasov Daniel , Tamimi Michael , Zhu Yingrong , Rosenthal Jonathan , Dygert Levi , Ristic Milan , Ishii Haruki , Valdes Eduard , Omari Mirza , Gurin Lindsey , Huang Joshua , Czeisler Barry M. , Kahn D. Ethan , Zhou Ting , Lin Jessica , Lord Aaron S. , Melmed Kara , Meropol Sharon , Troxel Andrea B. , Petkova Eva , Wisniewski Thomas , Balcer Laura , Morrison Chris , Yaghi Shadi , Galetta Steven 
Published: March 2021

ABSTRACTBackgroundLittle is known regarding long-term outcomes of patients hospitalized with COVID-19.MethodsWe conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep.ResultsOf 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N=196 neurological patients and N=186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 2.03, 95%CI 1.22-3.40, P=0.01), worse ADLs (aOR 0.38, 95%CI 0.29-0.74, P=0.01) and were less likely to return to work than controls (41% versus 64%, P=0.04). Cognitive and Neuro-QOL metrics were similar between groups.ConclusionsAbnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.
Underlying cardiovascular risk and major adverse cardiovascular events after acute respiratory infection: a population-based cohort study of over 4.2 million individuals in England, 2008-2018
Authors: Davidson Jennifer A , Banerjee Amitava , Smeeth Liam , McDonald Helen I , Grint Daniel , Herrett Emily , Forbes Harriet , Pebody Richard , Warren-Gash Charlotte 
Published: March 2021

ABSTRACTBackgroundWhile acute respiratory infections (ARIs) can lead to cardiovascular complications, the effect of underlying cardiovascular risk profile on ARI incidence and cardiovascular complications in those without established cardiovascular disease (CVD) is unknown. Whether to consider individuals at raised cardiovascular risk a priority group for vaccination against respiratory infections therefore remains unclear.MethodsWe conducted a cohort study in individuals aged 40-64 years without established CVD or a chronic health condition eligible for influenza vaccination, using Clinical Practice Research Datalink GOLD and Aurum data from 01/09/2008-31/08/2018 linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics mortality data from England. We classified cardiovascular risk based on diagnosed hypertension and overall predicted cardiovascular risk estimated using QRISK2 score (≥10% compared with <10%). Using multivariable Poisson regression models, we obtained incidence rate ratios (IRR) for ARI. Among individuals who had an ARI, we then used multivariable Cox regression to obtain hazard ratios (HR) for the risk of major adverse cardiovascular events (MACE) within one year of infection.Findings4,212,930 individuals were included; 12·5% had hypertension and 14·4% had a QRISK2 score ≥10%. After adjusting for confounders, patients with hypertension (IRR 1·04, 95% CI 1·03-1·05) or QRISK2 score ≥10% (IRR 1·39, 1·37-1·40) had a higher incidence of ARI. Of the 442,408 individuals with an ARI, 4,196 had a MACE within one year of infection. After adjustment, hypertension (HR 1·98, 1·83-2·15) and QRISK2 score ≥10% (HR 3·65, 3·42-3·89) were associated with substantial increased risk of a MACE after infection.InterpretationPeople without diagnosed CVD but who have raised cardiovascular risk, measured by diagnosed hypertension or, in particular, overall predicted cardiovascular risk, have increased incidence of both ARI and cardiovascular complications following an ARI.