bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Risk of Cardiac Complications in Collegiate Athletes After Asymptomatic or Mild COVID-19 Infection
Authors: Klawitter Paul , Cowen Leslie , Carhart Robert 
Published: June 2022

Objective:
The objective of this study was to determine the utility of “standard” cardiac screening with EKG, echocardiography, and serum troponin T (hs-Tn T) testing after COVID infection in competitive college athletes.

Design:
Prospective cohort study.

Setting:
Tertiary cardiology clinic, university training room.

Participants:
Sixty-five Division 1 athletes recovered from COVID-19 and 465 controls.

Assessment:
All COVID-recovered athletes underwent cardiac screening on return to campus in fall 2020. Controls were screened if indicated by preparticipation examination. Students cleared for sports participation were followed for the development of cardiac complications.

Main Outcome Measure:
Incidence of cardiac complications after COVID infection.

Results:
Infected athletes experienced mild (26/65), moderate (8/65), or no (31/65) COVID symptoms. No athletes had severe symptoms. Men were more likely to have been asymptomatic (20/31), and women were more likely to have had moderate (7/8) symptoms (P = 0.015). All athletes, except 2 with anosmia, were asymptomatic at the time of cardiac testing. One athlete had persistently elevated hs-Tn T but no evidence of myocarditis on cardiac MRI. All other cardiac testing was negative. No athletes were diagnosed with myocarditis (95% CI: 0%-5.5%). All athletes were cleared for athletic participation. None suffered complications over the next 9 months.

Conclusions:
After COVID-19 infection, no college athletes with mild, moderate, or no symptoms had signs of myocarditis, and all returned to play without cardiac complication. These findings support consensus opinion recommendations that college-age athletes who recovered from COVID-19 and who experienced mild or no symptoms may return to play without cardiac testing.
Healing Predictors of Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus
Authors: Kim Hyun Woo , Park Kun-Bo , Kim Chan Woo , Lee Koo Yeon , Park Hoon 
Published: June 2022

Objective:
To investigate the healing response of juvenile osteochondritis dissecans (JOCD) of the talus after conservative treatment, identify healing predictors, and develop a predictive model for healing.

Design:
Retrospective study.

Setting:
Clinics at a tertiary-level pediatric medical center.

Patients:
Fifty-five patients (55 ankles) who presented with JOCD.

Interventions:
Patients were managed with cast immobilization followed by activity restriction.

Main Outcome Measures:
The primary outcome measure of progressive lesion reossification was determined from the latest radiograph, after at least 6 months of nonoperative treatment. Final clinical evaluation was performed by a questionnaire and complementary telephone interview. Multivariate logistic regression was used to determine the influence of age, sex, lesion size, classification, location, duration of symptoms, containment lesion, and the occurrence of cyst-like lesions on healing potential.

Results:
After nonoperative treatment, 18 (33%) of 55 lesions had failed to progress toward healing. An older age (P = 0.034) and a completely detached but undisplaced (grade III) lesion (P < 0.001) at the time of diagnosis were predictive for the failure of conservative treatment. A multivariate logistic regression best predictor model that included age and grade resulted in the best predicted healing and yielded an area under the curve of 0.920 (P < 0.001).

Conclusion:
In two-thirds of skeletally immature patients, conservative treatment resulted in the progressive healing of JOCD of the talus. For older patients with grade III lesions showing a lower healing probability, surgical treatment should be considered.
Surviving cardiac arrest - what do we know about recovery & survivorship?
Authors: Sawyer Kelly N. 
Published: June 2022

Purpose of review
There has been increasing interest in examining how cardiac arrest survivors and their families experience life after sudden cardiac arrest (SCA). Understanding their experiences provides a basis to study tools and interventions to improve short- and long-term recovery and rehabilitation.

Recent findings
Qualitative interview and survey-style studies explored the lived experience of SCA survivors and revealed common themes (e.g., need for recovery expectations and long-term follow-up resources). A heightened awareness for the unique needs of family and loved ones of survivors led to qualitative studies focusing on these members as well. Methodology papers published portend prospective assessment and follow-up cohort studies. However, no investigations evaluating discharge processes or specific interventions directed at domain impairments common after SCA were identified in the review period. International work continues to identify patient and family-centered priorities for outcome measurement and research.

Summary
In line with increased recognition of the importance for recovery and rehabilitation after SCA, there has been a commensurate increase in investigations documenting the needs of survivors and families surviving SCA. Pediatric and underserved populations continue to be understudied with regards to recovery after SCA.
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest - who, when, and where?
Authors: Gottula Adam L. , Neumar Robert W. , Hsu Cindy H. 
Published: June 2022

Purpose of review
Extracorporeal cardiopulmonary resuscitation (ECPR) is an invasive and resource-intensive therapy used to care for patients with refractory cardiac arrest. In this review, we highlight considerations for the establishment of an ECPR system of care for patients suffering refractory out-of-hospital cardiac arrest (OHCA).

Recent findings
ECPR has been shown to improve neurologically favorable outcomes in patients with refractory cardiac arrest in numerous studies, including a single randomized control trial. Successful ECPR programs are typically part of a comprehensive system of care that optimizes all phases of OHCA management. Given the resource-intensive and time-sensitive nature of ECPR, patient selection criteria, timing of ECPR, and location must be well defined. Many knowledge gaps remain within ECPR systems of care, postcardiac arrest management, and neuroprognostication strategies for ECPR patients.

Summary
To be consistently successful, ECPR must be a part of a comprehensive OHCA system of care that optimizes all phases of cardiac arrest management. Future investigation is needed for the knowledge gaps that remain.
Artificial intelligence and clinical deterioration
Authors: Malycha James , Bacchi Stephen , Redfern Oliver 
Published: June 2022

Purpose of review
To provide an overview of the systems being used to identify and predict clinical deterioration in hospitalised patients, with focus on the current and future role of artificial intelligence (AI).

Recent findings
There are five leading AI driven systems in this field: the Advanced Alert Monitor (AAM), the electronic Cardiac Arrest Risk Triage (eCART) score, Hospital wide Alert Via Electronic Noticeboard, the Mayo Clinic Early Warning Score, and the Rothman Index (RI). Each uses Electronic Patient Record (EPR) data and machine learning to predict adverse events. Less mature but relevant evolutions are occurring in the fields of Natural Language Processing, Time and Motion Studies, AI Sepsis and COVID-19 algorithms.

Summary
Research-based AI-driven systems to predict clinical deterioration are increasingly being developed, but few are being implemented into clinical workflows. Escobar et al. (AAM) provide the current gold standard for robust model development and implementation methodology. Multiple technologies show promise, however, the pathway to meaningfully affect patient outcomes remains challenging.
Management of Magnet Ingestions at a Large Tertiary Care Children’s Hospital
Authors: Shaul Eliana , Agawu Atu , Wood Phoebe , Umhoefer Katherine , Mamula Petar 
Published: June 2022

Objectives:
To review the clinical management and outcomes of magnet ingestions at a large tertiary children’s hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets.

Methods:
Children <18 years who presented to the emergency room and were admitted to the Children’s Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) pre-ban (2008–2012), (2) intra-ban (2013–2016), and (3) post-ban (2017–2020).

Results:
There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3–9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms (P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) (P < 0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period (P = 0.021).

Conclusions:
Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.
Immunity response against mild-to-moderate breakthrough COVID-19
Authors: Mongkolsucharitkul Pichanun , Surawit Apinya , Sookrung Nitat , Tungtrongchitr Anchalee , Phisalprapa Pochamana , Sayabovorn Naruemit , Srivanichakorn Weerachai , Washirasaksiri Chaiwat , Auesomwang Chonticha , Sitasuwan Tullaya , Chaisathaphol Thanet , Tinmanee Rungsima , Chayakulkeeree Methee , Phoompoung Pakpoom , Tangjittipokin Watip , Senawong Sansanee , Sanpawitayakul Gornmigar , Muangman Saipin , Mayurasakorn Korapat ,   the SPHERE Investigators
Published: June 2022

ABSTRACTBACKGROUNDThe Omicron variant prevails the Delta variant after December 2021 in Thailand. Both variants of concern embody diverse epidemiological trends and immunogenicity, raising enormous public health concerns. We determined whether biological and clinical characteristics and immunogenicity of patients differ between Delta and Omicron during post-coronavirus disease 2019 (COVID-19) stage.METHODSA retrospective cohort study involved patients with mild-to-moderate COVID-19 who were under a home isolation (HI) strategy. Clinical outcomes and laboratory data of 2704 and 2477 patients during the Delta and Omicron pandemics were analyzed, respectively. We evaluated anti-receptor binding domain immunoglobulin G (anti-RBD IgG) and surrogate viral neutralizing (sVNT) activity in a subset of 495 individuals post-COVID-19 infection during the Delta pandemic.RESULTSEighty-four percent of all patients received antiviral treatment. The peak cycle threshold (Ct) values, which inversely related to viral load, were lower in the Omicron (19 [IQR=17-22]) compared with the Delta (21 [IQR=18-26]; p<0.001), regardless of vaccination status. Upper respiratory tract symptoms were common signs during the Omicron compared with the Delta pandemic. At least two-dose vaccination reduced the chance of hospital readmissions by 10–30% and death by less than 1%. Furthermore, anti-RBD IgG and sVNT against the Delta variants tended to be higher among the older individuals after post-COVID 19 infections and expressed in the long interval after two-dose vaccination than in other groups.CONCLUSIONSMild-to-moderate Delta and Omicron breakthrough infection with prior full vaccination is limitedly immunogenic; thereby exerting reduced protection against reinfection and infection from novel variants. However, this may be only sufficient to prevent hospitalization and death, particularly in countries where vaccines are limited. (ClinicalTrials.gov number, NCT05328479.)
Evaluating the yaws diagnostic gap: a survey to determine the capacity of and barriers to improving diagnostics in all yaws-endemic countries
Authors: Handley Becca L. , Tchatchouang Serges , Grout Lise , Johnson Roch Christian , Tabah Earnest Njih , Boua Bernard , Boock Alphonse Um , Koffi Aboa Paul , Phanzu Delphin Mavinga , Kotey Nana Konama , Rogers Emerson , Dofitas Belen , Jung Younghee , Maweke Tchalim , Beiras Camila G. , Maman Issaka , Basing Laud Anthony , Ngazoa Solange , Houezo Jean Gabin , Togbey Kwamy , Telan Elizabeth Freda , Sarmento Nevio , Marion Estelle , Addo Kwasi Kennedy , Mitjà Oriol , Asideu Kinsley , Harding-Esch Emma , Marks Michael 
Published: June 2022

AbstractBackgroundYaws, caused by Treponema pallidum subsp. pertenue, is a skin neglected tropical disease. It is targeted for eradication by 2030, primarily using mass drug administration (MDA) with azithromycin. Traditionally, diagnosis of yaws has relied on clinical examination and serological testing. However, these approaches have poor diagnostic performance. To achieve eradication, more accurate diagnostics are required to determine whether MDA should be initiated or continued as well as for post-elimination surveillance. Molecular tools will be crucial for detecting antimicrobial resistant cases, which have the potential to derail eradication efforts. In order to determine the feasibility of introducing novel, more accurate, diagnostics for yaws surveillance purposes, it is necessary to understand current in-country diagnostic capacity. This study therefore aimed to understand the current capacity of, and challenges to, improving diagnostics for yaws in all yaws-endemic countries worldwide.Methodology/ principal findingsAn online survey was sent to all 15 yaws-endemic countries in July 2021. The survey asked about past prevalence estimates, the availability of different diagnostic tools, and perceived barriers to enhancing capacity. Fourteen countries responded to the survey, four of which did not have a current National Policy for yaws eradication in place. Over 95% of reported that yaws cases from the past five years had not been confirmed with serological or molecular tools, largely due to the limited supply of rapid serological tests. Only four countries reported having operational laboratories for molecular yaws diagnosis, with only one of these having a validated assay to detect azithromycin resistance.Conclusions and SignificanceThis study highlights the diagnostic capacity constraints across all respondent countries. Countries are in need of access to a sustainable supply of serological tests, and development of molecular testing facilities. Sufficient sustainable funding should be made available to ensure that appropriate diagnostic tools are available and utilised.
A prospective study of adherence to lenalidomide for multiple myeloma using Medication Event Monitoring System (MEMS) caps
Authors: Silberstein Alice E. , Fiala Mark A. , Loh Kah Poh , Cordner Theresa , Mian Hira , Wildes Tanya M 
Published: June 2022

AbstractPurposeIn patients with multiple myeloma, characterizing adherence to orally administered therapies, such as lenalidomide, is critical given their frequent use and potential for poorer outcomes associated with nonadherence. However, little data exist using prospective measures of adherence in this population. Our study piloted use of Medication Event Monitoring System (MEMS) caps and the patient-reported Brief Adherence Rating Scale (BARS) for 3 months in older adults with multiple myeloma.MethodsWe enrolled 13 patients with multiple myeloma receiving lenalidomide. Baseline characteristics were summarized; mean adherence to lenalidomide was reported with 95% confidence intervals.ResultsThe median follow-up was 84 days. Of the 12 participants evaluable, median adherence, as assessed by the MEMS cap data, was 98%. Only 5 had 100% adherence. Deviations from intended use included missed prescribed doses made up during scheduled off week, additional days off between cycles, or taking fewer than anticipated days off. None of these events evident in MEMS data were self-disclosed. The mean difference in adherence estimated between the BARS and MEMS caps was 2%.ConclusionIn this small sample, the observed adherence was higher than reported in retrospective studies using Medication Possession Ratio as a proxy for adherence. The BARS can be easily integrated into clinical encounters but has potential for reporting bias. MEMS caps can help characterize patterns of nonadherence, though there are limitations to their utility and the data can require thorough manual review to reconcile suspected occurrences of nonadherence. Studies should use more than 1 complementary measure of adherence.Clinicaltrials.gov ID: NCT03779555, Registered 12/19/2018
Severe acute respiratory syndrome coronavirus 2 breakthrough infections in healthcare workers vaccinees with BNT162b2 (Pfizer-BioNtech) in Bogotá, Colombia
Authors: Tavera-Rodríguez Pilar , Barbosa-Ramírez Juliana , Bermúdez-Forero Andrea , Prada-Cardozo Diego , Reales-González Jhonnatan , Peláez-Carvajal Dioselina , Malo-Sanchez Diana , Meneses-Gil Maria-Ximena , Mercado-Reyes Marcela 
Published: June 2022

AbstractThe healthcare workers are considered as a high-risk group for infection with SARS-CoV-2, so they were included in the first stage of the National Plan for Vaccination against COVID-19 in Colombia.An ongoing prospective cohort study to evaluate immune response to vaccination included 490 workers from health institutions in Bogotá, Colombia, vaccinated between March and June 2021 with BNT162b2 (Pfizer-BioNtech). Multiple samples were collected during a follow-up period of 6 months after immunization. We report cases of asymptomatic and symptomatic SARS-CoV-2 infections detected in this cohort. For each participant demographic data, vaccination dates, results for SARS-CoV-2 RT-PCR, and detection of antibody (IgG) tests during the follow-up period were collected.SARS-CoV-2 infection was detected in 38 (7.7 %) volunteers. Of these, 81.6% had a positive RT-PCR for SARS-CoV-2, and 18.4% were confirmed by detection of IgG anti-SARS-CoV-2 nucleoprotein; 76.3% of infections occurred after 7 days of second dose. A total of 57.9% of the cases were asymptomatic. No hospitalizations or deaths were registered. When infection occurred, 81.6% of infected participants had presence of IgG anti-S antibodies. In 12 samples in which genomic characterization was achieved, 83.4% corresponded to the variant Mu, 8.3% Gamma, and 8.3% Delta.All findings agree with other reports in different studies that show the benefit of COVID-19 vaccines, protecting specially against severe disease but not against infection or re-infection.
Cilostazol and isosorbide mononitrate for the prevention of progression of cerebral small vessel disease: Baseline data and statistical analysis plan for the Lacunar Intervention Trial-2 (LACI-2) (ISRCTN14911850)
Authors: Bath Philip M , Mhlanga Iris , Woodhouse Lisa J , Doubal Fergus , Oatey Katherine , Montgomery Alan A , Wardlaw Joanna M ,   the LACI-2 Investigators
Published: June 2022

ABSTRACTBackgroundCerebral small vessel disease (SVD) causes lacunar strokes (25% of all ischaemic strokes), physical frailty and cognitive impairment and vascular and mixed dementia. There is no specific treatment to prevent progression of SVD.MethodsThe LACunar Intervention Trial-2 (LACI-2) is an investigator-initiated prospective randomised open-label blinded-endpoint (PROBE) phase II feasibility study assessing cilostazol and isosorbide mononitrate for preventing SVD progression. We aimed to recruit 400 patients with clinically-evident lacunar ischaemic stroke and randomised to cilostazol, isosorbide mononitrate, both or neither, in addition to guideline secondary ischaemic stroke prevention, in a partial factorial design. The primary outcome is feasibility of recruitment and adherence to medication; key secondary outcomes include: drug tolerability; recurrent vascular events, cognition and function at one year after randomisation; and safety (bleeding, falls, death). Data are number (%), and median [interquartile range].ResultsThe trial commenced on 5th of February 2018 and ceased recruitment on 31st of May 2021 with 363 patients randomised, with the following baseline characteristics: average age 64 [56.0, 72.0] years, female 112 (30.9%), stroke onset to randomisation 79.0 [27.0, 244.0] days, hypertension 267 (73.6%), median blood pressures 143.0 [130.0, 157.0]/83.0 [75.0, 90.0] mmHg, current smokers 67 (18.5%), educationally achieved end of school examinations (A-level) or higher 118 (32.5%), modified Rankin scale 1.0 [0.0, 1.0], National Institutes Health stroke scale (NIHSS) 1.0 (1.4), Montreal Cognitive Assessment 26.0 [23.0, 28.0] and total SVD score on brain imaging 1.0 [0.0, 2.0]. This publication summarises the baseline data and presents the statistical analysis plan.SummaryThe trial is currently in follow-up which will complete on 31 May 2022 with results expected in October 2022.
Symptom variation, correlations, and relationship to physical activity in Long Covid: intensive longitudinal study
Authors: Burton Christopher , Dawes Helen , Goodwill Simon , Thelwell Michael , Dalton Caroline 
Published: June 2022

AbstractBackgroundPeople with Long Covid (Post-Acute Sequelae of Covid-19) describe multiple symptoms which vary between and within individuals over relatively short time intervals. We aimed to describe the real-time associations between different symptoms and between symptoms and physical activity at the individual patient level.Methods and FindingsIntensive longitudinal study of 82 adults with self-reported Long Covid (median duration 12-18 months). Data collection involved a smartphone app with 5 daily entries over 14 days and continuous wearing of a wrist accelerometer. Data items included 7 symptoms (Visual Analog Scales) and perceived demands in the preceding period (Likert scales). Activity was measured using mean acceleration in the 3-hour periods preceding and following app data entry. Analysis used within-person correlations of symptoms pairs and both pooled and individual symptom networks derived from graphical vector autoregression.App data was suitable for analysis from 74 participants (90%) comprising 4022 entries representing 77.6% of possible entries. Symptoms varied substantially within individuals and were only weakly auto-correlated. The strongest between-subject symptom correlations were of fatigue with pain (partial coefficient 0.5) and cognitive difficulty with light-headedness (0.41). Pooled within-subject correlations showed fatigue correlated with cognitive difficulty (partial coefficient 0.2) pain (0.19) breathlessness (0.15) and light-headedness (0.12) but not anxiety. Cognitive difficulty was correlated with anxiety and light-headedness (partial coefficients 0.16 and 0.17). Individual participant correlation heatmaps and symptom networks showed no clear patterns indicative of distinct phenotypes.Symptoms, including fatigue, were inconsistently correlated with prior or subsequent physical activity: this may reflect adjustment of activity in response to symptoms. Delayed worsening of symptoms after the highest activity peak was observed in 7 participants.ConclusionSymptoms of Long Covid vary within individuals over short time scales, with heterogenous patterns of symptom correlation. The findings are compatible with altered central symptom processing as an additional factor in Long Covid.