bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial Mediterranean Fever in Pregnancy
Authors: Davidson Alana , Kuller Jeffrey A. , Dotters-Katz Sarah K. , Wood Rachel L. 
Published: November 2024

ABSTRACT

Importance
Though the incidence of familial Mediterranean fever (FMF) in pregnancy is rare, understanding the etiology and symptomatology of FMF is essential for obstetric treatment of patients with FMF.

Objective
Familial Mediterranean fever is a hereditary periodic fever syndrome that has unique obstetric considerations. Familial Mediterranean fever is typically characterized by recurrent episodes of high-grade fevers, pleuritis/pericarditis, and arthritis lasting 1–3 days with complete recovery seen in between episodes. Familial Mediterranean fever is seen worldwide, but particularly in patients of Mediterranean descent. Its incidence varies across ethnicities.

Evidence Acquisition
This article provides a comprehensive review of existing literature.

Results
It is well established that colchicine is safe and effective to use during pregnancy in patients with FMF to control and prevent flares. Although most pregnancies progress without negative outcomes, FMF has been shown in the literature to be associated with preterm birth and premature rupture of membranes. Its impact on increasing the rate of fetal growth restriction and hypertensive disorders is less understood. Additionally, FMF flares may be suppressed in pregnancy, whereas other sources report that flares are similar to those outside of pregnancy in terms of frequency, type of symptoms, and severity. Breastfeeding is safe in patients with FMF who are taking colchicine. Genetic counseling can be offered to patients with FMF, but in utero diagnostic testing is generally not pursued solely for the indication of FMF diagnosis in the fetus.

Conclusions and Relevance
Further investigation of the impact of FMF on pregnancy is needed for advancing our understanding of the condition and optimizing care for pregnant individuals with FMF.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After reading this review, the provider will be better able to describe the clinical significance and impact of FMF in pregnancy; explain the incidence, pathophysiology, diagnostic criteria, and treatment of FMF; and discuss genetic testing in the setting of a FMF diagnosis.
Contraceptive Strategies for Reducing the Risk of Reproductive Cancers
Authors: Aliabadi A. R. , Wilailak Sarikapan , McNally Orla , Berek Jonathan S. , Sridhar Aparna 
Published: November 2024

(Abstracted from Int J Gynaecol Obstet 2024;166(1):141–151)
Reproductive cancers include endometrial cancer, ovarian cancer, cervical cancer, and gestational trophoblastic neoplasia and represent a significant health burden across geographic locations and age groups, although there is evidence that some contraceptive methods can be protective against certain types of malignancies. This article is a review aimed to express the disease burden of different reproductive cancers as well as known evidence of contraceptives in the prevention and management of these diseases.
Maternal Hybrid Immunity and Risk of Infant COVID-19 Hospitalizations: National Case-Control Study in Israel
Authors: Guedalia Joshua , Lipschuetz Michal , Cahen-Peretz Adva , Cohen Sarah M. , Sompolinsky Yishai , Shefer Galit , Melul Eli , Ergaz-Shaltiel Zivanit , Goldman-Whol Debra , Yagel Simcha , Calderon-Margalit Ronit , Beharier Ofer 
Published: November 2024

(Abstracted from Nat Commun 2024;15:2846)
Infants with COVID-19, especially the Omicron variant, are at increased risk of acute respiratory failure and hospitalization. Pfizer and Moderna mRNA vaccines significantly reduce this risk but are not approved for infants under 6 months.
The Impact of COVID-19 on Patterns of Fractures Presenting to Pediatric Emergency Departments
Authors: Ruest Stephanie M. , Hanson Holly R. , Kiragu Andrew , Lee Lois K. , Zonfrillo Mark R. , Pomerantz Wendy J. 
Published: November 2024

Objective
To examine differences in pediatric fracture prevalence, severity, and mechanisms of injury before and during the COVID-19 pandemic.

Methods
This is a subanalysis of data from a multicenter, cross-sectional study of all injury-related visits to 40 urban pediatric emergency departments (EDs) for children younger than 18 years occurring January 2019–December 2020. ED visits for injuries including fractures were identified by International Classification of Diseases, Tenth Revision codes. Comparative analyses of patient demographics, fracture prevalence, severity, and mechanisms of injury for March 17, 2019, to December 31, 2019 (pre-COVID), versus March 15, 2020, to December 31, 2020 (during COVID), were performed.

Results
Fracture-related visits comprised 21.0% (n = 123,684) of all injury visits (n = 589,083) during the study period. There were 16,190 fewer fracture-related visits (−23.2%) in 2020 than 2019. There were differences in the proportion of fracture-related visits by age (P < 0.0001), with increases in children younger than 5 years and decreases in children 5 to 18 years old. There were higher proportions of visits in 2020 among female patients, White children, non-Hispanic children, and those with private insurance (P < 0.0001, respectively). Patients with fractures in 2020 were more severely injured, with higher proportions of hospitalizations (P < 0.0001), intensive care unit admissions (P < 0.0001), deaths (P = 0.007), and higher injury severity scores (P < 0.0001). Fracture mechanisms shifted to more motor vehicle crashes, bicycles, and firearms in 2020 (P < 0.0001).

Conclusions
Despite a decrease in fracture-related visits to urban pediatric EDs during the early COVID-19 pandemic, there was an increase in the proportion of ED visits for children younger than 5 years and higher severity injuries. These findings highlight injury epidemiology pattern shifts that occurred during the pandemic. Identifying higher-risk populations for fracture may help guide targeted education and prevention efforts.
Ivabradine Treatment to Prevent Anthracycline-Induced Cardiotoxicity: A Randomized Clinical Trial
Authors: Rizk Stephanie Itala , Costa Isabela Bispo Santos da Silva , Cruz Cecilia Beatriz Bittencourt Viana , Pileggi Brunna , Andrade Fernanda Thereza de Almeida , Gonzalez Thalita Barbosa , Bittar Cristina Salvadori , Fukushima Julia Tizue , Quintao Vinicius Caldeira , Osawa Eduardo Atsushi , Alves Juliana Barbosa Sobral , Fonseca Silvia Moulin Ribeiro , Garcia Diego Ribeiro , Pereira Juliana , Buccheri Valeria , Ávila Juliana , Kawahara Lucas Tokio , Barros Cecilia Chie Sakaguchi , Ikeoka Lucas Takeshi , Nakada Letícia Naomi , Fellini Mariella , Rocha Vanderson Geraldo , Rego Eduardo Magalhães , Hoff Paulo Marcelo Gehm , Kalil Filho Roberto , Landoni Giovanni , Hajjar Ludhmila Abrahão 
Published: November 2024

AbstractBackgroundCancer therapy-related cardiac dysfunction frequently occurs in patients receiving anthracycline. Ivabradine reduces the heart rate without affecting contractility and has shown anti-inflammatory, antioxidant, and antiapoptotic effects in experimental models of cardiotoxicity. This study aims to evaluate the effect of ivabradine on cancer therapy-related cardiac dysfunction incidence in patients with lymphoma or sarcoma treated with anthracycline.MethodsThis study was a prospective, randomized, and triple-blind trial. Patients starting anthracycline therapy were given either ivabradine 5 mg twice daily or placebo until 30 days after completing treatment. The primary outcome was a ≥10% relative reduction in global longitudinal strain at 12 months. The secondary outcomes included 12-month clinical outcomes, a ≥10% decrease in the left ventricular ejection fraction to <55%, diastolic dysfunction, and troponin T and NT-proBNP levels.ResultsThis study was conducted with 107 patients (51 in the ivabradine group and 56 in the placebo group). The median dose of anthracycline was 300 mg/m2(250--300 mg/m2) in both groups. A ≥10% relative reduction in global longitudinal strain at 12 months was reached in 57% of the ivabradine group and in 50% of the placebo group (OR 1.32, 95% CI: -0.612.83, p=.477). Fewer patients in the ivabradine group than in the placebo group had troponin T levels ≥14 ng/L [16 (39.0%) vs. 23 (62.2%), p=0.041] at 6 months. There were no differences in the other secondary outcomes.ConclusionsA fixed 10 mg/day dose of ivabradine does not protect cancer patients against anthracycline cardiotoxicity.Clinical trials registrationNCT03650205https://clinicaltrials.gov/study/NCT03650205?cond=NCT03650205&rank=1Clinical perspectivesThis study found that ivabradine at a fixed dose of 10 mg/day does not effectively prevent cardiotoxicity in cancer patients undergoing anthracycline (ANT) therapy, contrary to previous expectations.These findings suggest that ivabradine may not be sufficient as a cardioprotective agent in ANT therapy, emphasizing the need to explore additional or alternative strategies to manage cardiotoxicity in cancer patients.The study highlights a potentially complex interaction between ANT and cardiac tissue, indicating a need for further research to fully understand and address this risk.
Estimated benefit of PCSK9 inhibition following ischemic stroke due to severe intracranial atherosclerosis
Authors: Siegler James E. , Goicoechea Elena Badillo , Yaghi Shadi , Morsi Rami Z. , Arevalo Andrea , Smith Matthew M. , Kothari Sachin , Desai Harsh , Sehgal Neha , Rana Rohini , Kellogg Caroline , Jhaveri Aditya , de Havenon Adam , Dunne Therese , Cameron Kamil , Chaturvedi Seemant , Ghannam Malik , Prabhakaran Shyam , Coleman Elisheva , Brorson James R. , Mehendale Rachel , Kass-Hout Tareq 
Published: November 2024

ABSTRACTBackgroundThe risk of recurrent atherosclerotic vascular events in patients with stroke due to intracranial atherosclerotic disease (ICAD) is high. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) can dramatically lower low-density lipoprotein (LDL) levels when added to statins, but are not currently indicated for patients with ICAD.MethodsIn this secondary analysis of the SAMMPRIS trial, we estimated the association between LDL reduction (enrollment to day 30, by quartiles) and recurrent cerebral infarction or myocardial infarction (MI) beyond 30 days (primary outcome).Estimates were assessed using adjusted Cox proportional hazards regression accounting for age, sex, race, Hispanic ethnicity, baseline LDL, vascular comorbidities, and statin use prior to enrollment. We applied relative LDL reduction estimates from PCSK9i trials to project adjusted incidence rate differences of the primary outcome observed in SAMMPRIS with an equivalent LDL reduction. Semiparametric Cox models estimated the annualized relative risk of primary events if PCSK9i were used in the SAMMPRIS population.ResultsOf the 451 patients from SAMMPRIS, 378 met inclusion criteria. By day 30, LDL levels fell significantly (absolute change -19mg/dL, IQR -41 to -2). In unadjusted Cox regression compared to the lowest quartile, patients in the highest quartile of LDL improvement trended toward a lower rate of the primary outcome (Q4 vs. Q1 hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.35-1.26), achieving significance after multivariable adjustment (adjusted HR 0.38, 95% CI, 0.16-0.89). Every 10 mg/dL improvement in 30-day LDL was associated with a 9% lower rate of the primary outcome (adjusted HR 0.91, 95% CI, 0.83-0.997). Assuming an average projected effect of PCSK9i, with half of SAMMPRIS patients having been treated, PCSK9i use could reduce the annualized risk of the primary outcome by 33.2%.ConclusionsMore aggressive LDL lowering in patients with stroke due to ICAD is associated with lower rates of recurrent stroke or MI, and this can be achieved with PCSK9i use.
Genomic characterization uncovers transmission dynamics of Marburg Virus in Rwanda following a single zoonotic spillover event
Authors: Butera Yvan , Mutesa Leon , Parker Edyth , Muvunyi Raissa , Umumararungu Esperance , Ayitewala Alisen , Musabyimana Jean Pierre , Olono Alhaji , Sesonga Placide , Ogunsanya Olusola , Kabalisa Emmanuel , Adedokun Oluwatobi , Gahima Nelson , Irankunda Laetitia , Mutezemariya Chantal , Niyonkuru Richard , Uwituze Arlene , Uwizera Ithiel , Kagame James , Umugwaneza Arlette , Rwabuhihi John , Umwanankabandi Fidele , Mbonitegeka Valens , Ntagwabira Edouard , Kayigi Etienne , Izuwayo Gerard , Murenzi Herve , Mukankwiro Therese , Tuyiringire Nasson , Uwimana Jean Marie Vianney , Gasengayire Agnes , Sindayiheba Reuben , Onyeugo Glory-Ugochi , Aragaw Merawi , Gitundu Lenny , Bigirimana Radjabu , Fallah Mosoka , Ejikeme Adaora , Sembuche Senga , Kabanda Alice , Mugisha Jean Claude , Siddig Francis Emmanuel Edwar , Gashema Pierre , Ndayisenga Jerome , Rugamba Alexis , Kanyabwisha Faustin , Murenzi Gad , Happi Anise , Ngabonziza Jean Claude Semuto , Gashegu Misbah , Ahmed Ayman , Bigirimana Noella , Rwagasore Edson , Semakula Muhammed , Rwabihama Jean Paul , Musanabaganwa Clarisse , Seruyange Eric , Nkeshimana Menelas , Twagirumugabe Theogene , Turatsinze David , Remera Eric , Gahamanyi Noel , Tessema Sofonias Kifle , Mukagatare Isabelle , Nsanzimana Sabin , Happi Christian , Muvunyi Claude Mambo 
Published: November 2024

AbstractThe ongoing outbreak of Marburg virus disease (MVD) in Rwanda marks the third largest historically, though it has exhibited the lowest fatality rate. Genomic analysis has identified a lineage with limited internal diversity most closely related to a genome sequence from a sporadic case sampled in 2014 in Uganda, though the lineages have diverged from a common ancestor that was circulating for decades in the animal reservoir.Notably, the data also provide evidence that the outbreak resulted from a single zoonotic transmission event with limited human-to-human transmission, rather than multiple independent zoonotic transmission events. The Rwandan MVD outbreak prompted a thorough investigation that included contact tracing, clinical assessment, travel history, sequencing, and serology testing, to trace the virus’s origin. Results of investigations linked the index case to a mining cave inhabited byRousettus aegyptiacus(the Egyptian fruit bat), where three individuals tested seropositive for IgG and IgM, further supporting the zoonotic origin of the outbreak through human-animal interactions.
Zero-shot extraction of seizure outcomes from clinical notes using generative pretrained transformers
Authors: Ojemann William K.S. , Xie Kevin , Liu Kevin , Chang Ellie , Roth Dan , Litt Brian , Ellis Colin A. 
Published: November 2024

AbstractPurposePre-trained encoder transformer models have extracted information from unstructured clinic note text but require manual annotation for supervised fine-tuning. Large, Generative Pre- trained Transformers (GPTs) may streamline this process. In this study, we explore GPTs in zero- and few-shot learning scenarios to analyze clinical health records.Materials and MethodsWe prompt-engineered LLAMA2 13B to optimize performance in extracting seizure freedom from epilepsy clinic notes and compared it against zero-shot and fine-tuned Bio+ClinicalBERT models. Our evaluation encompasses different prompting paradigms, including one-word answers, elaboration-based responses, prompts with date formatting instructions, and prompts with dates in context.ResultsWe found promising median accuracy rates in seizure freedom classification for zero-shot GPT models: one-word – 62%, elaboration – 50%, prompts with formatted dates – 62%, and prompts with dates in context – 74%. These outperform the zero-shot Clinical BERT model (25%) but fall short of the fully fine-tuned BERT model (84%). Furthermore, in sparse contexts, such as notes from general neurologists, the best performing GPT model (76%) surpasses the fine-tuned BERT model (67%) in extracting seizure freedom.ConclusionThis study demonstrates the potential of GPTs in extracting clinically relevant information from unstructured EMR text, offering insights into population trends in seizure management, drug effects, risk factors, and healthcare disparities. Moreover, GPTs exhibit superiority over task-specific models in contexts with the potential to include less precise descriptions of epilepsy and seizures, highlighting their versatility. Additionally, simple prompt engineering techniques enhance model accuracy, presenting a framework for leveraging EMR data with zero clinical annotation.Competing InterestsThe authors declare no financial or non-financial competing interests.
Enhancing retention on antiretroviral therapy at 6 months using interactive two-way texting: findings from a randomized controlled trial in Lilongwe, Malawi
Authors: Kiruthu-Kamamia Christine , Klabbers Robin E. , Tweya Hannock , Huwa Jacqueline , Thawani Agness , Bisani Pachawo , Chintedza Joseph , Chiwaya Geldert , Kudzala Aubrey G. , Ndhlovu Dumisani , Seyani Johnnie , Groot Wim , Pavlova Milena , Feldacker Caryl 
Published: November 2024

AbstractAntiretroviral therapy (ART) retention is critical for achieving viral load suppression (VLS) among people living with HIV (PLHIV). Retention remains challenging in high-prevalence settings like Malawi. Short messaging service (SMS) interventions, particularly hybrid two-way texting (2wT), show promise in improving ART retention. We conducted a randomized control trial (RCT) at Lighthouse Trust in Lilongwe, Malawi, to evaluate the effectiveness of a hybrid 2wT system to improve early retention, appointment attendance, and VLS among new ART initiates within six months of ART initiation. After receiving routine ART initiation counseling, 452 new ART clients with mobile phones were randomized to 2wT or standard of care (SoC). The 2wT group received weekly motivational messages, appointment reminders, and had access to an open-ended SMS communication channel with healthcare workers. The SoC group received peer support at clinic visits and visit reminder phone calls. All participants were traced if they missed a clinic appointment by 14 days. Study outcomes included: retention in care (alive on ART), appointment adherence (attending within 2 days), and VLS (< 200 copies) at six months. Data from electronic medical records were analyzed using Chi-square tests and multivariable logistic regression. At six months post ART initiation, the 2wT group demonstrated significantly higher appointment adherence (59.6% vs. 46.8%, p = 0.008) and VLS (97.5% vs. 93.2%, p=0.007) compared to SoC. Among both 2wT and SoC, 91% remained in care (p=0.68). Although retention among 2wT and SoC at 6 months did not differ, 2wT clients were more likely to attend clinic visits on time and reach VLS in the first six months. The low-tech 2wT approach offers a scalable, appropriate intervention to enhance visit compliance and VLS among PLHIV with mobile phones. Implementing 2wT study over a longer time frame and among more clients would likely provide evidence for scaling 2wT more broadly.
Characterization of human senescent cell biomarkers for clinical trials
Authors: Farr Joshua N. , Monroe David G. , Atkinson Elizabeth J. , Froemming Mitchell N. , Ruan Ming , LeBrasseur Nathan K. , Khosla Sundeep 
Published: November 2024

ABSTRACTThere is an increasing need for blood-based biomarkers of senescent cell burden to facilitate selection of participants for clinical trials. Potential candidates includep16Ink4aexpression in peripheral blood T-cells and circulating protein concentrations of the senescence-associated secretory phenotype (SASP).p16Ink4ais encoded by theCDKN2Alocus, which produces six variant transcripts in humans, two of which encode homologous p16 proteins: p16Inka4a, encoded byp16_variant 1, and p16Ɣ, encoded byp16_variant 5. While distinct quantitative polymerase chain reaction primers can be designed forp16_variant 5, primers forp16_variant 1also measurep16_variant 5(p16_variant 1+5). In a recent clinical trial evaluating effects of the senolytic combination, dasatinib + quercetin (D+Q), on bone metabolism in postmenopausal women, we found that women in the highest tertile for T-cell expression ofp16_variant 5had the most robust skeletal responses to D+Q. Importantly, assessment ofp16_variant 5was more predictive of these responses thanp16_variant 1+5. Here, we provide a comprehensivein vitroandin vivocharacterization ofp16_variant 5expression.In vitro, p16_variant 1increased rapidly (week 1) following the induction of DNA damage, whereasp16_variant 5increased later (week 4), consistent with the latter being more specific for an established senescent state. Further analysis of our clinical trial data identified a SASP panel in plasma that correlated withp16_variant 5expression in T-cells and performed as well in identifying postmenopausal women with a positive skeletal response to D+Q. Collectively, our findings support that the assessment of T-cellp16_variant 5expression may be more specific for senescence and provide further support for this assay as a biomarker for selecting participants in clinical trials of senolytic interventions. In addition, our data indicate that correlated plasma SASP markers could be used in lieu of the more technically challenging T-cellp16assay. Finally, the ability to identify individuals with a beneficial skeletal response to D+Q using two different measures of senescent cell burden (i.e., the T-cellp16assay and the SASP score) provides further support for the hypothesis that the underlying senescent cell burden dictates the clinical response to a senolytic intervention.
Optimal deployment of limited vaccine supplies to combat mpox
Authors: Berry Matthew T , MacIntyre C Raina , Cromer Deborah , Hacker Adam , Davenport Miles P , Khoury David S 
Published: November 2024

AbstractMpox outbreaks in Central Africa have been declared a public health emergency of international concern by the World Health Organization. Fortunately, real-world effectiveness studies of the MVA-BN vaccine indicate that it has an effectiveness of 74% after one dose, and 82% after two doses against mpox. However, given the very limited supply of vaccines in Central Africa, there remain questions around the optimal deployment of limited MVA-BN doses. In this study, we consider whether more mpox cases might be averted by following the traditional two-dose vaccine regimen (4 week dosing interval), or by giving a single dose of MVA-BN to as many individuals as possible. We find that the optimal strategy depends on both, (i) the degree to which a subpopulation might be at higher risk of mpox, or severe mpox, infections, and (ii) how long ago the first dose was administered to the most at-risk subpopulation.