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Kutluk, M. Tezer, and Akif Yeşilipek. "Pediatric cancer registry in Turkey 2009-2020 (TPOG & TPHD)." Journal of Clinical Oncology 39, no. 15_suppl (2021): e22519-e22519. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e22519.
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e22519 Background: Global actions on pediatric cancer control is targeting to improve the survival rates in low and middle income countries which already exceeded 80% in high income countries. Almost 300.000 pediatric cancer cases annually are expected in children and adolescents aged 0-14 globally. Pediatric cancer registry must be a priority within the pediatric cancer control programs. Here, we present the most updated results of the pediatric cancer registry in Turkey. Methods: Pediatric cancer registry has been established by the Turkish Pediatric Oncology Group and Turkish Pediatric Hematology Association in 2002. The childhood cancer cases registered between 2009-2020 was included in this analysis. International Childhood Cancer Classification System was used for the classification. Essential demographic findings, ICD-O-3 morphology and topography codes were recorded for each case. Results: During the 12 years from 2009 to 2020, 21792 cases were registered. For all cases, median age was 6.7 year (0-19; M/F 12198/9584, 4 hermaphrodite, 6 unknown). Age distribution was 0-4 yrs, 40.9%; 5-9 yrs, 23.7%; 10-14 yrs, 23.4%; 15-19 yrs, 12.0%) The distribution of the tumor types were [number of cases, percentage of total, median age yrs, M/F]: Leukemia (5208, 23.9%, 5.5, 3004/2204); Lymphoma & other RES tumors (4103, 18.8%, 9.8, 2733/1367, 1 hermaphrodite & 2 unknown); CNS [brain & spinal] (3269, 15.0%, 6.8, 1794/1474, 1 unkown); Symphatetic system (1794, 8.2%, 2.4, 933/861); Retinoblastoma (610, 2.8%, 1.4, 339/271); Renal (1079, 5.0%, 3.1, 524/553, 1 hermaphrodite & 1 unknown); Liver (376, 1.7%, 2.2, 216/160); Malignant bone (1448, 6.6%, 12.5, 787/661); Soft tissue sarcomas (1554, 7.1%, 7.6, 888/666); Germ cell (1461, 6.7%, 9.3, 547/910, 2 hermaphrodite, 2 unknown); Carcinoma & other malignant epithelial (745, 3.4%, 13.5, 362/383); Other/non-specific malignant (145, 0.7%, 7.9, 71/74). Five year survival rate was found as 72%. Conclusions: This registry shows the imrovement of survival rates to 72% in Turkey which is comparable with middle income countries. The pediatric cancer control community is investing on the control of childhood cancer for further improvement and this registry became a valuable source for pediatric oncology community at national and international level.
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Hulin, Cyrille, Thierry Facon, Chaim Shustik, et al. "Effect of Age on Efficacy and Safety Outcomes in Patients (Pts) with Newly Diagnosed Multiple Myeloma (NDMM) Receiving Lenalidomide and Low-Dose Dexamethasone (Rd): The First Trial." Blood 124, no. 21 (2014): 81. http://dx.doi.org/10.1182/blood.v124.21.81.81.
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Abstract Background: In the pivotal FIRST trial, a randomized, international, multicenter phase 3 study, continuous Rd compared with melphalan-prednisone-thalidomide (MPT) improved progression-free survival (PFS) which was the primary endpoint (HR = 0.72; P < 0.01). The interim overall survival (OS) analysis showed a 22% reduction in risk of death with continuous Rd vs. MPT (HR = 0.78; P = 0.02) (Facon, Blood 2013). This analysis evaluates outcomes based on age, which was a stratification parameter, and compared pts aged ≤ 75 yrs and > 75 yrs. Methods: Pts with NDMM were randomized to continuous Rd until progressive disease (PD) (N = 535); 18 cycles (72 weeks [wks]) of Rd (Rd18; N = 541); or 12 cycles (72 wks) of MPT (N = 547). Starting doses were reduced in pts aged > 75 yrs: dexamethasone (20 vs. 40 mg), melphalan (0.20 vs. 0.25 mg/kg), and thalidomide (100 vs 200 mg). The primary endpoint was PFS (continuous Rd vs. MPT) and the secondary endpoint were OS, overall response rate, time to response, duration of response, time to Tx failure, time to 2nd AMT, health-related quality of life, safety. Results: The proportion of pts aged > 75 yrs was > 34% across treatment (Tx) arms. In pts ≤ 75 yrs, 37% had ISS stage III vs. 51% in > 75 yrs. ECOG score ≥ 1 was observed in 74% and 69% of pts aged > 75 and ≤ 75 yrs, respectively. Severe renal impairment (CrCl < 30 mL/min) was observed in 14% of pts > 75 vs. 7% in ≤ 75 yrs. PFS and OS outcomes favored continuous Rd over MPT in both age groups. With a median follow-up of 37 months (mos), PFS was 27.4 mos in continuous Rd pts vs. 21.8 mos in MPT pts aged ≤ 75 yrs (HR = 0.68; P < 0.001); a trend for improved PFS was also seen for pts aged > 75 yrs (HR = 0.81; P = 0.11) (Table 1). PFS for continuous Rd vs. Rd18 pts was also increased in both age groups (HR = 0.68; P < 0.001 and HR = 0.75; P = 0.03, respectively). Response rates were consistently higher with continuous Rd vs. MPT in pts aged ≤ 75 yrs (77% vs. 66%; P < 0.001) and > 75 yrs (71% vs. 55%; P < 0.001). Duration of response with continuous Rd was longer vs. MPT in pts aged ≤ 75 yrs (40 vs. 22 mos) and pts > 75 yrs (31 vs. 24 mos). The interim analysis of OS showed an improved trend for continuous Rd vs. MPT in pts aged ≤ 75 yrs (HR = 0.77; P = 0.06) and > 75 yrs (HR = 0.80; P= 0.16). Grade 3–4 adverse events (AEs) in ≥ 10% of pts were similar across age subgroups (Table 2). Tx discontinuation due to AEs was comparable across the Tx groups and independent of age. Conclusions:Regardless of age (≤ 75 vs. > 75 yrs), continuous Rd was effective, increased PFS and interim OS, and was generally well tolerated vs. MPT in NDMM pts. Duration of response was improved with continuous Rd vs. MPT and Rd18, irrespective of age, and with a more profound benefit observed in younger pts. Continuous Rd represents a new clinical option and standard of care for these pts in the first-line setting. Abstract 81. Table 1 PFS, OS and Response Aged ≤ 75 yrs Aged > 75 yrs All pts ITT population Continuous Rd (n = 349) Rd18 (n = 348) MPT (n = 359) Continuous Rd (n = 186) Rd18 (n = 193) MPT (n = 188) Continuous Rd (n = 535) Rd18 (n = 541) MPT (n = 547) Median PFS, mos 27.4 21.3 21.8 21.2 19.4 19.2 25.5 20.7 21.2 PFS HR (95% CI); P-value Continuous Rd vs. Rd18 0.68 (0.55–0.83); P < 0.01 0.75 (0.58–0.98); P = 0.03 0.70 (0.60–0.82); P < 0.01 Continuous Rd vs. MPT 0.68 (0.56–0.83); P < 0.01 0.81 (0.62–1.05); P = 0.11 0.72 (0.61–0.85); P < 0.01 4-yr OS, % 66 61 58 47 47 39 59 56 51 OS HR (95% CI); P-value Continuous Rd vs. Rd18 0.88 (0.67–1.16); P = 0.36 0.94 (0.69–1.29); P = 0.70 0.90 (0.73–1.10); P = 0.31 Continuous Rd vs. MPT 0.77 (0.59–1.01); P = 0.06 0.80 (0.59–1.09); P = 0.16 0.78 (0.64–0.96); P = 0.02 Response rate (≥ PR), % 77 77 66 71 66 55 75 73 62 Duration of response (≥ PR), mos 40 23 22 31 20 24 35 22 22 CI, confidence interval; ITT, intent to treat; PR, partial response. Table 2 Grade 3–4 AEs Observed in ≥ 10% of Pts Aged ≤ 75 yrs Aged > 75 yrs Safety population, % Continuous Rd (n = 347) Rd18 (n = 348) MPT (n = 357) Continuous Rd (n = 185) Rd18 (n = 192) MPT (n = 184) Neutropenia 28 25 47 28 29 40 Thrombocytopenia 8 9 13 9 7 7 Anemia 18 12 20 19 23 17 Leukopenia 5 6 11 4 5 8 Infections 29 21 16 29 23 20 DVT and/or PE 10 6 8 7 8 4 Peripheral sensory neuropathy 1 1 10 1 0 8 Tx discontinuation due to AEs 28 18 28 32 25 30 DVT, deep-vein thrombosis; PE, pulmonary embolism. Disclosures Hulin: Celgene: Honoraria. Off Label Use: Lenalidomide used in newly diagnosed multiple myeloma patients. Facon:Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Belch:Janssen, Celgene, Onyx: Honoraria. Petrucci:Celgene, Janssen-Cilag, Sanofi, Bristol-Myers Squibb: Honoraria. Dührsen:Celgene: Honoraria, Research Funding. Song:Celgene: Consultancy, Honoraria, Research Funding. Houck:Celgene: Employment. Chen:Celgene: Employment. Ervin-Haynes:Celgene: Employment.
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Makanya, A. N., J. N. Maina, T. M. Mayhew, S. A. Tschanz, and P. H. Burri. "A stereological comparison of villous and microvillous surfaces in small intestines of frugivorous and entomophagous bats: species, inter-individual and craniocaudal differences." Journal of Experimental Biology 200, no. 18 (1997): 2415–23. http://dx.doi.org/10.1242/jeb.200.18.2415.
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The extents of functional surfaces (villi, microvilli) have been estimated at different longitudinal sites, and in the entire small intestine, for three species of bats belonging to two feeding groups: insect- and fruit-eaters. In all species, surface areas and other structural quantities tended to be greatest at more cranial sites and to decline caudally. The entomophagous bat (Miniopterus inflatus) had a mean body mass (coefficient of variation) of 8.9 g (5%) and a mean intestinal length of 20 cm (6%). The surface area of the basic intestinal tube (primary mucosa) was 9.1 cm2 (10%) but this was amplified to 48 cm2 (13%) by villi and to 0.13 m2 (20%) by microvilli. The total number of microvilli per intestine was 4 x 10(11) (20%). The average microvillus had a diameter of 8 nm (10%), a length of 1.1 microns (22%) and a membrane surface area of 0.32 micron 2 (31%). In two species of fruit bats (Epomophorus wahlbergi and Lisonycteris angolensis), body masses were greater and intestines longer, the values being 76.0 g (18%) and 76.9 g (4%), and 73 cm (16%) and 72 cm (7%), respectively. Surface areas were also greater, amounting to 76 cm2 (26%) and 45 cm2 (8%) for the primary mucosa, 547 cm2 (29%) and 314 cm2 (16%) for villi and 2.7 m2 (23%) and 1.5 m2 (18%) for microvilli. An increase in the number of microvilli, 33 x 10(11) (19%) and 15 x 10(11) (24%) per intestine, contributed to the more extensive surface area but there were concomitant changes in the dimensions of microvilli. Mean diameters were 94 nm (8%) and 111 nm (4%), and mean lengths were 2.8 microns (12%) and 2.9 microns (10%), respectively. Thus, an increase in the surface area of the average microvillus to 0.83 micron 2 (12%) and 1.02 microns 2 (11%) also contributed to the greater total surface area of microvilli. The lifestyle-related differences in total microvillous surface areas persisted when structural quantities were normalised for the differences in body masses. The values for total microvillous surface area were 148 cm2g-1 (20%) in the entomophagous bat, 355 cm2g-1 (20%) in E. wahlbergi and 192 cm2g-1 (17%) in L. angolensis. This was true despite the fact that the insecteater possessed a greater length of intestine per unit of body mass: 22 mm g-1 (8%) versus 9-10 mm g-1 (9-10%) for the fruit-eaters.
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Santos, G. M. G., K. C. Silva-Santos, T. R. R. Barreiros, et al. "233 HIGH NUMBERS OF ANTRAL FOLLICLES INFLUENCE THE IN VITRO EMBRYO PRODUCTION, BUT NOT THE CONCEPTION RATE OF FIXED-TIME ARTIFICIAL INSEMINATION IN NELORE CATTLE." Reproduction, Fertility and Development 27, no. 1 (2015): 206. http://dx.doi.org/10.1071/rdv27n1ab233.
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The aim of this study was to compare the conception rates to fixed-time artificial insemination (FTAI) and in vitro embryo production between Nelore cows with high or low antral follicle counts (AFC). First, multiparous Nelore cows (Bos indicus, n = 547, 40–60 days postpartum) were subjected to synchronization of ovulation. Randomly during their oestrous cycle (Day 0), cows received an intravaginal device containing 1.9 g of P4 (CIDR®) and 2 mg of oestradiol benzoate (Estrogin®), intramuscularly. At device removal (Day 8), cows received 500 µg of PGF2α (Ciosin®), 300 IU of eCG (Novormon®), and 1 mg of oestradiol cipionate (ECP®), intramusculary. All cows were inseminated 48 h after P4 device removal. Antral follicles = 3 mm were counted using an intravaginal microconvex transducer (Day 0), and cows were assigned to groups of high (G-High, = 25 follicles, n = 183), intermediate (G-Intermediate, 16–20 follicles, n = 183), or low AFC (G-Low, = 10 follicles, n = 181). In another study to compared the in vitro embryo production, Nelore cows (n = 66, 72–96 months) were subjected to ultrasound-guided follicular aspiration using an intravaginal microconvex array transducer (7.5 MHz). The COC were selected and cows were assigned to groups according to the oocyte production: G-High (n = 22, = 40 oocytes), G-Intermediate (n = 25, 18–25 oocytes), or G-Low (n = 19, = 7 oocytes). Previously tested semen from a single bull was used for IVF using a previously described protocol (Silva-Santos et al. 2014 Reprod. Domest. Anim. 49, 228–232). The oocyte and embryo production (viable embryo: grade I, II, III; vitrifiable embryo: grade I, II) were evaluated. The number of follicles was evaluated by Kruskal-Wallis, and the chi-square test was used for data on oocyte and embryo production (P = 0.05). The average follicular population was 30.7 ± 5.7 (G-High), 18.6 ± 1.64 (G-Intermediate), and 7.8 ± 2.4 follicles (G-Low; P < 0.05), but there were no differences in the conception rates among groups (51.9 v. 48.6 v. 58.6%, respectively; P > 0.05). The total number of oocytes recovered were 1109 (G-High), 534 (G-Intermediate), and 101 (G-Low; P < 0.05). The mean number of viable oocytes was 40.4 ± 10.6 (G-High), 14.8 ± 3.0 (G-Intermediate), and 3.8 ± 1.1 (G-Low; P < 0.05) and the percentage of viable oocytes was 80% (G-High), 69% (371/534, G-Intermediate), and 71% (G-Low; P < 0.05). Cleavage rate was 79% (G-High), 74% (348/472, G-Intermediate), and 71% (G-Low; P < 0.05), and blastocyst rate was 42% (G-High), 32% (153/472, G-Intermediate), and 13% (G-Low; P < 0.05). The number of viable embryos was 18.4 ± 6.7 (G-High), 6.1 ± 3.6 (G-Intermediate), and 0.6 ± 0.7 (G-Low; P < 0.05) and the percentage of vitrifiable embryos was 81% (G-High), 77% (118/153, G-Intermediate), and 58% (G-Low; P < 0.05). Therefore, Nelore cows with high oocyte production had ~10-fold higher oocyte production and produced ~30-fold more embryos compared with the low AFC group. In conclusion, AFC had no influence on the conception rates to FTAI; however, Nelore cows with high oocyte production exhibited higher in vitro embryo production.
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Перескоков, Михаил Львович, та Дарья Алексеевна Якимова. "ОПЫТ СТАТИСТИЧЕСКОГО И ПРОСТРАНСТВЕННОГО АНАЛИЗА КЕРАМИКИ ГЛЯДЕНОВСКОГО КОСТИЩА (ПО МАТЕРИАЛАМ РАСКОПОК 2015–2018 ГОДОВ): ПЕРВЫЕ РЕЗУЛЬТАТЫ". Археология Евразийских степей, № 2 (30 квітня 2021): 175–90. http://dx.doi.org/10.24852/2587-6112.2021.2.175.190.
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В статье представлены результаты апробации комплексной методики изучения керамического материала Гляденовского костища (конец VI в. до н.э. – V в. н.э.). Гляденовское костище – сложный культовый объект, имеющий слабо стратифицированный культурный слой, что существенно усложняет решение вопросов хронологии памятника. Предлагаемая методика может помочь в решении данной задачи. Исследование включало следующие этапы. Была создана база данных керамики, которая отражает качественные признаки орнаментации. Статистическая таблица учитывала технику нанесения орнамента, отдельные элементы орнамента, комбинации элементов – орнаментальные мотивы, а так же и орнаментальные композиции в целом. Сложные композиции дают уникальный набор признаков. Данные представлены в бинарном коде и подвержены статистическому анализу, который выполнялся последовательно двумя методами: кластерным иерархическим анализом и методом главных компонент. После этого, полученные результаты кластеризации и группировки распределения в координатах ГК. Выделенные кластеры и группы отражают стилистические и хронологические особенности керамики Гляденовского костища. После этого инструментами ГИС проведен пространственный анализ расположения керамического материала в пространстве культурного слоя, с учетом результатовстатистического анализа. Подтвержден стратиграфический принцип формирования культурного слоя костища. Выявлены особенности распределения различных типов керамики в пространстве памятника.
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Pruskowski, Kaitlin A., and Leopoldo C. Cancio. "507 Outcomes After the Administration of Hydroxocobalamin." Journal of Burn Care & Research 41, Supplement_1 (2020): S90. http://dx.doi.org/10.1093/jbcr/iraa024.139.
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Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.
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Serdán Ruiz, David Leonardo, Katterine Kariuxy Vásquez Bone, and Ana Emperatriz Yupa Pallchisaca. "LAS INFECCIONES EN EL TRACTO URINARIO EN LA MUJER EMBARAZADA Y SU INCIDENCIA EN LA MORBILIDAD Y MORTALIDAD DE NEONATOS." Universidad Ciencia y Tecnología 24, no. 106 (2020): 102–8. http://dx.doi.org/10.47460/uct.v24i106.402.
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La infección del tracto urinario de origen bacteriano es una patología frecuente en la mujer embarazada. Constituye un importante factor de riesgo asociado con el desarrollo de sepsis neonatal. La sepsis neonatal es una infección invasiva generalmente acompañada de bacteriemia que se presenta en el neonato en el primer mes de vida. Es una de las causas principales de morbilidad y mortalidad neonatal. El objetivo de esta investigación fue mostrar la relación entre la infección en el tracto urinario en la madre embrazada y la morbilidad y mortalidad del neonato. Se realizó un estudio de casos y controles que incluyó una muestra intencional y no probabilística de 224 pacientes, dividida en dos grupos de interés: 70 casos de neonatos nacidos de mujeres diagnosticadas conla infección y 154 controles de neonatos nacidos de mujeres sanas. Se realizó un análisis bivariado aplicando la prueba Chi cuadrado y estimando el Odds Ratio con apoyo del software OpenEpi, v3. El estudio mostró que los neonatos nacidos de madres con infección del tracto urinario tienen mayor riesgo de desarrollar sepsis neonatal, y sugiere que esta patología, una vez diagnosticada, puede ser tratada con eficacia evitando consecuencias graves para la salud del recién nacido.
 Palabras Clave: Infección, tracto urinario, sepsis neonatal, riesgo en el embarazo.
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 [23]B. Fernández, "Sepsis del recién nacido", Servicio de Neonatología, Universidad de Asturias, Asturias, 2017.
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Thomas, Deborah A., Susan O'Brien, Jeffrey Jorgensen, et al. "Significance of Minimal Residual Disease (MRD) by Multiparameter Flow Cytometry (MFC) In Adults with De Novo Acute Lymphoblastic Leukemia (ALL) After Therapy with the Modified Hyper-CVAD Regimen." Blood 116, no. 21 (2010): 2145. http://dx.doi.org/10.1182/blood.v116.21.2145.2145.
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Abstract Abstract 2145 The hyper-CVAD regimen is an effective frontline program for de novo adult ALL [Kantarjian, JCO 18:547, 2000; Kantarjian, Cancer 101:2788, 2004]. Intensive cycles of hyper-CVAD (fractionated cyclophosphamide, vincristine [VCR], doxorubicin, dexamethasone) alternate with high dose methotrexate (MTX) and cytarabine every 21 days for 8 courses, followed by maintenance therapy with POMP (6-mercaptopurine, MTX, VCR, prednisone) interrupted with early and late intensifications. The regimen was modified in 1999 in order to improve on the results. Induction chemotherapy was administered in a laminar air flow room for pts aged 60 years or older owing to high induction mortality rate (17%). Rituximab 375 mg/m2 (days 1 & 11 of hyper-CVAD, days 1 & 8 of MTX-cytarabine for 8 total doses) was given if CD20 expression was > 20% owing to association with increased propensity for relapse [Thomas D, Blood 113:6330, 2009]. CNS prophylaxis alternated intrathecal MTX day 2 with cytarabine day 7 of the first 3 courses for low CNS risk and first 4 courses for high CNS risk (in the absence of CNS disease). The maintenance phase was extended from 24 to 30 mos with modifications of the early and late intensifications (hyper-CVAD followed by MTX-L-asparaginase mos 6 & 7 and 18 & 19) in order to reduce incidence of late relapses. Newly diagnosed or primary refractory (1 course only) pts with Philadelphia chromosome negative B-lymphoblastic leukemia (n=126) were treated with this modified hyper-CVAD regimen without anthracycline intensification (pts age 30 years or less have been allocated to treatment with the pediatric-inspired augmented Berlin-Frankfurt-Muenster regimen since 2006). Median age was 43 yrs (range, 15–83). CD20 expression was noted in 49%. Overall CR rate of the group was 93%; the rate of MRD negativity by 4- or 6-color MFC (sensitivity of 0.01%) at the time of CR in 95 evaluable pts was 72%. Overall, MRD positivity by MFC at the time of CR was associated with a higher relapse rate (52% versus 21%, p=.01) and lower 3-yr CR duration rates (45% versus 78%, p=.01). The CD20 positive pts (n=57) who were treated with rituximab had a higher rate of MRD negativity by MFC at CR than their CD20 negative counterparts (81% versus 58%, p=.02). MRD positivity by MFC after hyper-CVAD and rituximab was associated with a significantly lower 3-yr CR duration rate (24% versus 82%, p=.002), but survival rates were not statistically different (27% versus 70%) likely due in part to deaths in CR in the older subset of the MRD-negative group. In contrast, for the CD20 negative subset, presence of detectable MRD by MFC at the time of CR was not associated a with lower 3-yr CR duration rate (58% versus 63%). Dectectable MRD by MFC at the time of CR, despite subsequent eradication with consolidation chemotherapy in the majority of patients, predicts for increased risk of disease recurrence. Strategies to improve the MRD negativity rate at the time of CR (e.g., addition of monoclonal antibodies directed at other lymphoblast antigens such as CD22 for the CD20 negative subset and use of the newer anti-CD20 monoclonal antibodies for the CD20 positive subset) may further improve outcome after frontline therapy with the modified hyper-CVAD regimens. Disclosures: Thomas: Novartis: Honoraria; Bristol-Meyer-Squibb: Honoraria; Pfizer:; Amgen: Research Funding. Off Label Use: Imatinib for de novo Philadelphia positive ALL. Dasatinib for de novo Philadelphia positive ALL. Rituximab for CD20 positive ALL and Burkitt leukemia/lymphoma. Nelarabine for de novo T-lymphoblastic leukemia/lymphoma.
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Bishr, Amr S., Salma M. Abdelaziz, Ibrahim S. Yahia, Mahmoud A. Yassien, Nadia A. Hassouna, and Khaled M. Aboshanab. "Association of Macrolide Resistance Genotypes and Synergistic Antibiotic Combinations for Combating Macrolide-Resistant MRSA Recovered from Hospitalized Patients." Biology 10, no. 7 (2021): 624. http://dx.doi.org/10.3390/biology10070624.
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Macrolide-resistant methicillin-resistant Staphylococcus aureus (MAC-MRSA) is one of the most clinically relevant pathogens due to its significant ability of resistance acquisition to different antimicrobial agents. This study aimed to evaluate antimicrobial susceptibility and the use of different combinations of azithromycin with other antibiotics for combating MAC resistance. Seventy-two Staphylococci (38.5%) (n = 187), showed resistance to MACs; of these, 53 isolates (73.6%, n = 72) were S. aureus and 19 (26.4%, n = 72) were coagulase-negative staphylococci (CoNS). Out of the 53 S. aureus and 19 CoNS isolates, 38 (71.7%, n = 53) and 9 (47.4%, n = 19) were MRSA and methicillin-resistant CoNS, respectively. The constitutive MACs, lincosamides and streptogramin-B (cMLS) comprised the predominant phenotype among S. aureus isolates (54.7%) and CoNS isolates (78.9%). The PCR analysis showed that the ermC gene was the most prevalent (79.2%), followed by msrA (48.6%), and ermA (31.9%). Azithromycin combinations with either linezolid, ceftriaxone, gentamicin, or cefotaxime provided synergy in 42.1%, 44.7%, 31.6% and 7.9% of the 38 MAC-MRSA isolates, respectively. Statistical analysis showed significant association between certain MAC resistance genotypes and the synergistic effect of certain azithromycin combinations (p value < 0.05). In conclusion, azithromycin combinations with either linezolid, or ceftriaxone showed synergism in most of the MAC-resistant MRSA clinical isolates.
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Dagher, Hiba, Anne-Marie Chaftari, Ray Y. Hachem, et al. "356. The Role of Procalcitonin in Antimicrobial Stewardship Among Cancer Patients Admitted with COVID-19." Open Forum Infectious Diseases 8, Supplement_1 (2021): S282. http://dx.doi.org/10.1093/ofid/ofab466.557.
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Abstract Background Procalcitonin (PCT) has been used to guide antimicrobial therapy in bacterial infections. With the wide spread use of empiric use of antibiotics in cancer patients admitted with COVID-19 disease, we aimed to evaluate the role of PCT in decreasing the duration of empiric antimicrobial therapy among cancer patients admitted with COVID-19. Methods We conducted a retrospective study of cancer patients admitted to MD Anderson Cancer Center who had a PCT test done within 72 hours of admission following their COVID-19 diagnosis between March 1, 2020 and June 6, 2021. Patients were divided into 2 groups of PCT &lt; 0.25 ng/mL and PCT &gt;=0.25 ng/mL. We assessed pertinent cultures including blood and respiratory, as well as antibacterial use and duration of empiric antibacterial therapy. Results We identified 544 patients with a median age of 62 years (range, 14-93). There were 312 (57%) patients that had at least one culture obtained from a sterile or infected site within 7 days following admission. None of the patients who had PCT&lt; 0.25 had a positive culture whereas 41/111 (37%) patients with PCT &gt;= 0.25 had at least one positive culture [P&lt; 0.0001]. Among the 373 patients who had a PCT &lt; 0.25, 129 (35%) patients received more than 72 hours of IV antibiotics compared to 87/171 (51%) among patients with PCT &gt;=0.25 [P= 0.0003]. Conclusion These results confirm the correlation between a PCT level greater than 0.25 and a documented bacterial infection. Furthermore, procalcitonin could be useful in enhancing antimicrobial stewardship in cancer patients with COVID-19 by reducing the duration of antimicrobial therapy beyond the initial empiric 72 hours until PCT results become available. Disclosures Natalie J Dailey Garnes, MD, MPH, AlloVir (Other Financial or Material Support, collaborator on research protocol)
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Leggett, Amanda, Hyun Jung Koo, Lindsay Kobayashi, Jessica Finlay, Hannah Lee, and Elaina Baker. "Older Adults’ Worry about COVID-19: Associations with Experiences of COVID-19 Among Social Connections." Innovation in Aging 5, Supplement_1 (2021): 739–40. http://dx.doi.org/10.1093/geroni/igab046.2749.
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Abstract The COVID-19 pandemic has challenged the physical and mental health of older adults, yet it is unknown how much older adults worry about their own exposure. As older adults are at increased risk for severe complications from COVID-19, understanding patterns of worry may inform public health guidelines and interventions for this age group. We investigated older adults’ worry about COVID-19 in the early months of the pandemic and associations with familial/friend’s diagnosis or disease symptoms. Data comes from the baseline (April/May 2020), one-month, and two-month follow-up surveys from the COVID-19 Coping Study, a national longitudinal cohort study of US adults aged ≥55. We used linear regression models to investigate the association between self-reported familial/friend diagnosis or symptoms with pandemic worry, accounting for demographic factors and individual diagnosis or experience of COVID-19 symptoms. Participants (Baseline=4379, 1 month= 2553, 2 month=2682) were 67 years old on average, 72% were female, 5.7% were non-White, and 80.5% had a college degree. At baseline, 26.6% of participants had friends or family who had been diagnosed or experienced symptoms of COVID-19. Having friends or family diagnosed or with symptoms of COVID-19 (B=0.08, SE=0.04, p&lt;.05), being female (B=0.42, SE=0.03, p&lt;.001), and having higher educational attainment (B=0.06, SE=0.02, p&lt;.001) were significantly associated with greater worry about COVID-19. These associations were consistent over 3 months. Understanding if worry about the pandemic correlates with following public health guidelines is a key next step so intervention strategies can prioritize older adults and their social networks.
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Ya-Ying, Liu. "Comparisons of recent data of density scale height at 544-877 km with CIRA model." Annales Geophysicae 14, no. 2 (1996): 222–26. http://dx.doi.org/10.1007/s00585-996-0222-4.
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Abstract. In order to obtain the observed scale height at high altitude a calculation method has been derived for determining density scale height from the difference between two satellite's heights. Two balloon satellites, Chinese DQ-1A and DQ-1B, were launched together into a nearly circular orbit at a height near 900 km and they were together in orbit for 190 days. According to the difference of the orbital heights of these two balloon satellites from 19 September 1990 to 9 March 1991, 67 values of density scale height at heights of about 544–877 km were determined. In comparison with CIRA model the results show that: (1) the trend of the variation of the scale height with height is in agreement with CIRA; (2) the determined scale height values present an oscillatory variation with time and height; and (3) the mean of the observed scale height is 3.7% lower than the mean of corresponding values from CIRA-72 and 0.8% lower than CIRA-86.
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LUCAS, P. "James R. Lewis, Editor, The Oxford Handbook of New Religious Movements, Oxford University Press, New York (2004) ISBN 0 19 514 9866 xv+544 pp., $72." Religion 36, no. 4 (2006): 237–38. http://dx.doi.org/10.1016/j.religion.2006.02.008.
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Lim, Sarah, Pamela Schreiner, Alan Lifson, et al. "527. Lower Risk of ICU Admission with Remdesivir in Patients Hospitalized with COVID-19 Pneumonia." Open Forum Infectious Diseases 8, Supplement_1 (2021): S364. http://dx.doi.org/10.1093/ofid/ofab466.726.
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Abstract Background Remdesivir (RDV) was approved by FDA in October 2020 for use in hospitalized patients with COVID-19. We examined the association between RDV treatment and ICU admission in patients hospitalized with COVID-19 pneumonia requiring supplemental oxygen (but not advanced respiratory support) in MN. Methods COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) is population-based surveillance of hospitalized laboratory confirmed cases of COVID-19. We analyzed COVID-NET cases ≥18 years hospitalized between Mar 23, 2020 and Jan 23, 2021 in MN for which medical record reviews were complete. On admission, included cases had evidence of COVID-19 pneumonia on chest imaging with oxygen saturation &lt; 94% on room air or requiring supplemental oxygen. Cases were excluded if treated with RDV after ICU admission. Multivariable logistic regression was performed to assess the association between RDV treatment and ICU admission. Results Complete records were available for 8,666 cases (36% of admissions statewide). 1,996 cases were included in the analysis, of which 908 were treated with RDV. 83% of cases were residents of the 7-county metro area of Minneapolis-St. Paul. Mean age was 59.7 years (IQR 48-72), 55% were male, and the mean RDV treatment duration was 4.8 days (range 2-15). The proportion of cardiovascular disease (30.6% vs 23.9%, p=.003), renal disease (16.6% vs 7.6%, p&lt; .001), and diabetes (34.7% vs 29.5%, p=0.01) was higher in the RDV untreated group, while obesity (22.3% vs 8.4%, p&lt; .001) and dexamethasone use (54.7% vs 15%, p&lt; .001) was more common in the RDV treated group. RDV untreated patients were more likely to be admitted to an ICU (18% vs 8.9%, p&lt; .001) and had higher inpatient mortality than those treated with RDV (11% vs 4.4%, p&lt; .001). After adjustment for dexamethasone use, age, sex and diabetes, treatment with RDV was associated with 48% lower odds of ICU admission (OR 0.52, 0.39-0.7, p&lt; .001). Conclusion We found RDV treatment associated with a significantly lower risk of ICU admission in patients admitted to hospital requiring supplemental oxygen, suggesting that treatment may prevent disease progression in this group. Further studies should assess the potential benefit of RDV combination treatment with dexamethasone. Disclosures Ruth Lynfield, MD, Nothing to disclose
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Abdelghany, Youmna, Kharisa Rachmasari, Sergio Alvarez-Mulett, Rochelle Wong, and Kapil Rajwani. "Incidence and management of pneumothorax, pneumomediastinum, and subcutaneous emphysema in COVID-19." SAGE Open Medicine 10 (January 2022): 205031212211247. http://dx.doi.org/10.1177/20503121221124761.
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Objective: The coronavirus disease 2019 (COVID-19) pandemic reached New York City in March 2020, leading to a state of emergency that affected many lives. Patients who contracted the disease presented with different phenotypes. Multiple reports have described the findings of computed tomography scans of these patients, several with pneumothoraces, pneumomediastinum, and subcutaneous emphysema. Our aim was to describe the incidence and management of pneumothorax, pneumomediastinum, and subcutaneous emphysema related to COVID-19 found on radiologic imaging. Methods: A retrospective chart review was conducted of all confirmed COVID-19 patients admitted between early March and mid-May to two hospitals in New York City. Patient demographics, radiological imaging, and clinical courses were documented. Results: Between early March and mid-May, a total of 1866 patients were diagnosed with COVID-19 in the two hospitals included in the study, of which 386 were intubated. The majority of these patients were men (1090, 58.4%). The distribution of comorbidities included the following: hypertension (1006, 53.9%), diabetes (544, 29.6%), and underlying lung disease (376, 20.6%). Among the 386 intubated patients, 65 developed study-specific complications, for an overall incidence of 16.8%; 36 developed a pneumothorax, 2 developed pneumomediastinum, 1 had subcutaneous emphysema, and 26 had a combination of both. The mean time of invasive ventilation was 14 days (0–46, interquartile range = 6–19, median 11). The average of highest positive end expiratory pressure within 72 h of study complication was 11 (5–24) cmH20. The average of the highest peak inspiratory pressure within 72 h of complication was 35.3 (17–52) cmH2O. In non-Intubated patients, 9/1480 had spontaneous pneumothorax, for an overall incidence of 0.61 %. Conclusion: Intubated patients with COVID-19 pneumonia are at high risk of pneumothorax, pneumomediastinum, and subcutaneous emphysema. These should be considered in differential diagnosis of shortness of breath or hypoxia in a patient with a new diagnosis of COVID-19 or worsening hemodynamics or respiratory failure in an intensive care unit setting.
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Zhabitska, L. A., and L. A. Zhabitska. "Endometriosis impact on the course of pregnancy and obstetric outcomes." REPRODUCTIVE ENDOCRINOLOGY, no. 60 (September 24, 2021): 31–33. http://dx.doi.org/10.18370/2309-4117.2021.60.31-33.
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Today, the issues of the pregnancy course in women with endometriosis and endometriosis impact on obstetric outcome remain unresolved and insufficiently studied.Research objective: to study the association between endometriosis and pregnancy complications, adverse obstetric outcomes.Materials and methods. A retrospective cohort study comparing the incidence of pregnancy complications and adverse obstetric outcomes in 478 women with endometriosis (main group) and 544 women without endometriosis (control group). Complications of pregnancy and unfavorable obstetric outcomes were assessed, such as spontaneous miscarriage, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta, postpartum hemorrhage and small for gestational age fetuses.Results. The study showed that pregnant women with endometriosis have an increased risk of spontaneous miscarriages compared to the control group: 89/478 (19.07 ± 1.13%) versus 87/544 (14.93 ± 0.49%) respectively (p < 0.001), ectopic pregnancy: 12/478 (2.84 ± 0.47%) versus 5/544 (0.97 ± 0.36%) respectively (p < 0.001); vomiting of pregnant women: 86/478 (17.85 ± 1.09%) compared with 16/544 (3.15 ± 0.34%) respectively (p < 0.001); premature birth: 72/478 (15.5 ± 1.03%) versus 55/544 (10.17 ± 0.30%) respectively (p < 0.001); increased frequency of caesarean section: 99/478 (20.44 ± 1.24%) versus 87/544 (15.5 ± 0.73%) respectively (p < 0.001) and pathological attachment of the placenta: 19/478 (4.31 ± 0.59%) versus 8/544 (1.46 ± 0.30%) respectively (p < 0.001).There was no association between endometriosis and postpartum hemorrhage and small gestational age of the fetus.Conclusions. Pregnant women with endometriosis have an increased risk of spontaneous miscarriages, ectopic pregnancy, vomiting of pregnant women, premature birth, caesarean section, pathological attachment of the placenta. The association established in our study between endometriosis and complications of pregnancy, unfavorable obstetric results requires further research to clarify the mechanisms of the results obtained.
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Thomas, Deborah A., Hagop M. Kantarjian, Jeffrey L. Jorgensen, et al. "Outcomes for Adult Lymphoblastic Leukemia (ALL) Are Mainly Influenced by Age and Status of Minimal Residual Disease (MRD) by Multiparameter Flow Cytometry (MFC) After Therapy with the Modified Hyper-CVAD (with or without Rituximab) Regimen." Blood 118, no. 21 (2011): 1524. http://dx.doi.org/10.1182/blood.v118.21.1524.1524.
Texto completo da fonteResumo:
Abstract Abstract 1524 The hyper-CVAD regimen is an effective frontline program for de novo adult ALL [Kantarjian, JCO 18: 547, 2000; Kantarjian, Cancer 101: 2788, 2004]. Intensive cycles of hyper-CVAD (fractionated cyclophosphamide, vincristine [VCR], doxorubicin, dexamethasone) alternate with high dose methotrexate (MTX) and cytarabine every 21 days for 8 courses, followed by maintenance therapy with POMP (6-mercaptopurine, MTX, VCR, prednisone) interrupted by early and late intensifications. The regimen was modified in 1999 to include use of laminar air flow rooms during the induction phase for pts aged 60 years or older. Rituximab 375 mg/m2 (Days 1 & 11 of hyper-CVAD, Days 1 & 8 of MTX-cytarabine for 8 total doses) was administered for CD20 expression > 20% to counteract increased propensity for relapse [Thomas D, Blood 113: 6330, 2009]. Early anthracycline intensification with liposomal daunorubicin and cytarabine was incorporated from 1999–2000 then omitted from the regimen [Thomas D, Cancer 116: 4580, 2010]. CNS prophylaxis alternated intrathecal MTX day 2 with cytarabine day 7 of the first 3 courses for low CNS risk and first 4 courses for high CNS risk (in the absence of CNS disease). Maintenance therapy was extended from 24 to 30 months inclusive of early and late intensifications (hyper-CVAD followed by weekly MTX and L-asparaginase mos 6 & 7 then mos 18 & 19) to reduce incidence of late relapses. Results in the CD20 positive B-lymphoblastic subset treated with hyper-CVAD and rituximab were encouraging; 3-yr rates of CR duration (CRD) and survival (OS) were 60% and 50% overall, respectively. In younger (age < 60 years) CD20-positive subset, rates of CRD and OS were superior compared with standard hyper-CVAD (70% v 38%; P <.001% and 75% v 47%, P =.003) [Thomas D, JCO 28: 3830, 2010]. Historical experience in the adolescent and young adult (AYA) subset aged 15 – 30 yrs with CD20 positive B-lymphoblastic leukemia (now treated with pediatric augmented BFM regimen) showed that the addition of rituximab improved the 3-yr CRD rates from 26% to 65% (P =.001) and 3-yr OS rates from 47% to 75% (P =.05) compared with standard hyper-CVAD. There were no significant differences in outcome for the AYA subset by regimen (standard or modified) for the CD20 negative groups (all 3-yr rates > 70%). In contrast to the Burkitt leukemia experience, elderly pts with CD20 positive B-lymphoblastic leukemia treated with hyper-CVAD and rituximab did not benefit (rates of CRD 45% v 50%, P = NS and OS 28% v 32%, P = NS, respectively), related in part to deaths in CR. For the modified hyper-CVAD regimen (no anthracycline intensification), the rate of MRD negativity by 4- or 6-color MFC (sensitivity 0.01%, assay now 8-color MFC) at the time of CR in 95 evaluable pts was 72%. Overall, MRD positivity by MFC at the time of CR was associated with a higher relapse rate (52% v 21%, P =.01) and lower 3-yr CR duration rates (45% v 78%, P =.01). CD20 positive pts treated with rituximab had a higher rate of MRD negativity by MFC at CR than their CD20 negative counterparts (81% v 58%, P =.02). MRD positivity by MFC after hyper-CVAD and rituximab was associated with a significantly lower 3-yr CR duration rate (24% v 82%, P =.002), but survival rates were not statistically different (27% v 70%) likely due in part to deaths in CR in the older subset of the MRD-negative group. In contrast, for the CD20 negative subset, presence of detectable MRD by MFC at the time of CR did not influence 3-yr CR duration rate (58% v 63%). Additional doses of rituximab have been added to the consolidation cycles (Day 1 of cycles 5 – 8) and during the maintenance phase. Upfront dose reductions have been implemented for the induction-consolidation phase according to age and performance status in order to reduce deaths in CR. MTX-cytarabine cycles now include vincristine. All pts receive 8 IT treatments in the absence of CNS disease. Younger pts age 40 – 50 yrs receive pegylated asparginase (2000 Units/m2 with capping) during the induction-consolidation phase and early/late intensifications (augmented hyper-CVAD). Elderly pts or younger pts with B-lymphoblastic leukemia with contraindications to asparaginase are now treated with the hyper-CVAD and ofatumumab regimen regardless of CD20 expression. The cumulative experience of the serial modifications to the hyper-CVAD regimen stratified by age/MRD status and the preliminary experience with the frontline version of the augmented hyper-CVAD regimen will be presented. Disclosures: Off Label Use: Rituximab in Lymphoblastic Leukemia.
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Mitina, Olga V., Anna P. Bachkala, and Olga V. Morozova. "THE STUDY OF THE MOTIVATIONAL STRUCTURE OF THE COLLECTIVE SUBJECT UNDER THE CONDITIONS OF THE COVID-19 PANDEMIC: A PSYCHOSEMANTIC APPROACH." Вестник Пермского университета. Философия. Психология. Социология, no. 4 (2022): 531–42. http://dx.doi.org/10.17072/2078-7898/2022-4-531-542.
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The pandemic has brought humans fear for themselves and their loved ones, and frustration because of changes in habitual behavior. All this led to emotional dynamics and, therefore, to changes in the motivational structure not only randomly at the individual level, but also systematically at the group level. We have developed two attribu-tive psychosemantic techniques that we used to construct operational models of motivational space based on ac-tions and judgments actual at the time of the pandemic. In two studies conducted in Moscow and Tashkent, we aimed to identify and study the motivational features of behavior during the COVID-19 pandemic. 1) In Tash-kent, the motivational space was constructed using the methodology of attribution of motives to beliefs about COVID-19. The study involved 76 respondents (38 men and 38 women) between the ages of 20 and 33 (M = 23,8, SD = 3,4). 2) The method of attribution of motives to behavior was applied in Moscow. We surveyed 112 respondents (74 females and 38 males), aged 15 to 72 years (M = 33.2, SD = 15.2). In both studies, we used a snowball sampling technique (research participants asked their acquaintances to be surveyed). The data were ana-lyzed using factor analysis. In both cases, the Safety motive was extracted as the first factor, followed by the mo-tives of Strengthening social relations and Self-Determination. The fourth factor differed: in the Tashkent sample, the motive of Distrust was extracted, and in the Moscow one, Conformism. We interpreted the results in the framework of the self-determination theory of E. Desi and R. Ryan and the motivation theory of A. Maslow
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Low, Jia Ming, Le Ye Lee, Yvonne Peng Mei Ng, Youjia Zhong, and Zubair Amin. "Breastfeeding Mother and Child Clinical Outcomes After COVID-19 Vaccination." Journal of Human Lactation 38, no. 1 (2021): 37–42. http://dx.doi.org/10.1177/08903344211056522.
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Background: Pre-approval clinical trials of the Pfizer/BioNTech messenger RNA COVID-19 vaccine, BNT162b2 did not include participants who were breastfeeding. Therefore, there is limited evidence about outcomes of breastfeeding mother–child dyads and effects on breastfeeding after vaccination. Research Aims: To determine: (1) solicited adverse effects (e.g., axillary lymphadenopathy, mastitis, and breast engorgement), which are unique to lactating individuals; and (2) systemic and local adverse effects of COVID-19 mRNA vaccine on mothers and potential effects on their breastfed infants. Method: This was a prospective cohort study of lactating healthcare workers ( N = 88) in Singapore who received two doses of BNT162b2 vaccination (Pfizer/BioNTech). The outcomes of mother–child dyads within 28 days after the second vaccine dose were determined through a participant-completed questionnaire. Results: Minimal effects related to breastfeeding were reported by this cohort; three of 88 (3.4%) participants had mastitis, one (1.1%) participant experienced breast engorgement, five of 88 (5.7%) participants reported cervical or axillary lymphadenopathy. There was no change in human milk supply after vaccination. The most common side effect was pain/redness/swelling at the injection site, which was experienced by 57 (64.8%) participants. There were no serious adverse events of anaphylaxis or hospital admissions. There were no short-term adverse effects reported in the infants of 67 lactating participants who breastfed within 72 hr after BNT162b2 vaccination. Conclusions: BNT162b2 vaccination was well tolerated in lactating participants and was not associated with short-term adverse effects in their breastfed infants. Study Protocol Registration: The study protocol was registered at clinicaltrials.gov (NCT04802278).
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Simbaña-Rivera, Katherine, Pablo R. Morocho Jaramillo, Javier V. Velastegui Silva, et al. "High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU." PLOS ONE 17, no. 3 (2022): e0262423. http://dx.doi.org/10.1371/journal.pone.0262423.
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Background Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes. Methods A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15th to July 15th, 2020. Results From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5–24.0), compared to 9 points (IQR: 5.0–22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group. Conclusion There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.
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Kolin, David A., Kaitlin M. Carroll, Kevin Plancher, and Fred Cushner. "Perspective of Attending Physicians on the Use of Telemedicine in an Outpatient Arthroplasty Setting During the COVID-19 Pandemic." HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery 17, no. 1 (2021): 31–35. http://dx.doi.org/10.1177/1556331620979984.
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Background: During the worldwide COVID-19 pandemic, physicians had to improvise and adapt new ways to provide care to patients. Purposes: The purpose of this study was to assess physicians’ sentiments regarding telemedicine and its use in orthopedic practices. Methods: We performed a cross-sectional study of attending orthopedic physicians, the majority of whom integrated telemedicine into their practices from March to October 2020. A survey was sent to 517 physicians who had registered for an orthopedics conference. The survey included questions pertaining to various factors regarding telemedicine and each physician’s practice. Results: Of the 517 physicians who received the survey, 328 responded, for a 63.4% response rate. Of the 328 respondents, 84.1% did not use telemedicine in their practice prior to the COVID-19 pandemic. Even during the pandemic, the physicians most commonly responded that less than 5% of their practice was conducted by telemedicine (n = 103, 31.4%). The second most common response was that more than 20% of visits were done via telemedicine (n = 72, 22.0%); 43.0% of physicians noted that they would not use telemedicine technology in their practice after the pandemic, but 59.1% of physicians would be willing to do annual visits by telemedicine. Ability to examine the patient (2.0 ± 1.0) was rated worse, overall, than either the experience using the technology (3.2 ± 1.0) or the capacity to communicate with the patient (3.6 ± 1.0). Conclusions: Our survey of orthopedic surgeons demonstrates that while the use of telemedicine technology was minimal prior to the pandemic, its use was widely adopted during the pandemic. Nearly half of physicians said that they will continue to use telemedicine.
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Ruiz-Huerta, Claudia, Marcelle V. Canto, Carmen Ruiz, et al. "COVID-19 Mortality in Patients Aged 80 and over Residing in Nursing Homes—Six Pandemic Waves: OCTA-COVID Study." International Journal of Environmental Research and Public Health 19, no. 19 (2022): 12019. http://dx.doi.org/10.3390/ijerph191912019.
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During the first COVID-19 pandemic wave in Spain, 50% of deaths occurred in nursing homes, making it necessary for some hospitals to support these facilities with the care of infected patients. This study compares origin, characteristics, and mortality of patients admitted with COVID-19 during six pandemic waves in the Hospital Central de la Cruz Roja in Madrid. It is a retrospective observational study of patients ≥ 80 years old, admitted with an acute SARS-CoV-2 infection, with a total of 546 patients included, whose final outcome was death or discharge. During the first wave, those from nursing homes had a higher risk of death than those from home; during the two successive waves, the risk was higher for those from home; and in the last two waves, the risk equalized and decreased exponentially in both groups. Men had 72% higher risk of death than women. For each year of age, the risk increased by 4% (p = 0.036). For each Charlson index point, the risk increased by 14% (p = 0.019). Individuals in nursing homes, despite being older with higher comorbidity, did not show a higher overall lethality. The mortality decreased progressively in each successive wave due to high vaccination rates and COVID-19 control measures in this population.
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Castagna, Antonella, David Shu Cheong Hui, Kathleen M. Mullane, et al. "548. Baseline characteristics associated with clinical improvement and mortality in hospitalized patients with moderate COVID-19." Open Forum Infectious Diseases 7, Supplement_1 (2020): S340. http://dx.doi.org/10.1093/ofid/ofaa439.742.
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Abstract Background Remdesivir (RDV) has been shown to shorten recovery time and was well tolerated in patients with severe COVID-19. Here we report baseline characteristics associated with clinical improvement at day (d) 14. Methods We enrolled hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation &gt;94% on room air, and radiological evidence of pneumonia. Patients were randomized 1:1:1 to receive 5d or 10d of intravenous RDV once daily plus standard of care (SoC), or SoC only. For this analysis, patients were followed through discharge, d14, or death. Baseline demographic and disease characteristics associated with clinical improvement in oxygen support (≥2-point improvement on a 7-category ordinal scale ranging from discharge to death) were evaluated using multivariable logistic regression methods. Results 584 patients were randomized and treated (5/10d RDV, n=384; SoC: n=200). 159 (27%) were ≥65y, 227 (39%) female, 328 (61%) white, 102 (19%) Asian, and 99 (19%) Black. 252 participants (43%) were enrolled in Europe, 260 (45%) North America (NA), and 72 (12%) in Asia. Most patients (483 [83%]) were not on supplemental oxygen but required medical care at baseline. In a multivariable model, 5/10d RDV was significantly positively associated with clinical improvement (adjusted odds ratio [OR] 1.69, 95% CI: 1.08, 2.65; p=0.0226). Significant covariables positively associated with clinical improvement included age &lt; 65y (p&lt; 0.0001) and region of treatment (Europe and NA vs Asia, p&lt; 0.0001 each; Table); other examined factors were not significantly associated with clinical improvement, including gender, race, ethnicity, baseline oxygen support, duration of symptoms and hospitalization, obesity, and baseline transaminase levels. Table 1. Conclusion In moderate COVID-19 patients, after adjusting for treatment arm, age &lt; 65y and region (NA vs Asia; Europe vs Asia) were associated with higher rates of clinical improvement. These observations recapitulate younger age as positive prognostic factor, and highlight the differences in the impact of the pandemic globally. Disclosures Antonella Castagna, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) David Shu Cheong Hui, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Kathleen M. Mullane, DO, PharmD, Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator) Mamta Jain, MD, Gilead Sciences Inc. (Scientific Research Study Investigator, Research Grant or Support)GlaxoSmithKline (Advisor or Review Panel member)Janssen (Research Grant or Support)Merck (Research Grant or Support) Massimo Galli, MD, Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Other Financial or Material Support, Personal fees) Shan-Chwen Chang, MD, PhD, Gilead Sciences Inc. (Scientific Research Study Investigator) Robert H. Hyland, MD, Gilead Sciences Inc. (Employee, Shareholder) Devi SenGupta, MD, Gilead Sciences Inc. (Employee, Shareholder) Huyen Cao, MD, Gilead Sciences Inc. (Employee, Shareholder) Hailin Huang, PhD, Gilead Sciences Inc. (Employee, Shareholder) Anand Chokkalingam, PhD, Gilead Sciences (Employee) Anu Osinusi, MD, Gilead Sciences (Employee) Diana M. Brainard, MD, Gilead Sciences (Employee) Christoph Lübbert, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) David Chien Boon Lye, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) David Chien Boon Lye, MD, NO DISCLOSURE DATA Judith A. Aberg, MD, Theratechnology (Consultant) Enrique Navas Elorza, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Karen T. Tashima, MD, Bristol-Myers Squibb (Research Grant or Support)Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator)GlaxoSmithKline (Research Grant or Support)Merck (Research Grant or Support)Tibotec (Research Grant or Support)Viiv Healthcare (Research Grant or Support) Mark McPhail, MD, Gilead Sciences Inc. (Scientific Research Study Investigator)
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Devinder Kumar Vohra, Nawab Singh, Manchanda JK, et al. "A comparative study of wave 1 and 2 mortality factors among COVID-19 patients in a level 3 medical college hospital in Saharanpur India." Asian Journal of Medical Sciences 13, no. 5 (2022): 1–6. http://dx.doi.org/10.3126/ajms.v13i5.41558.
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Background: In COVID-19, second wave death rate climbed in several states of India including Uttar Pradesh with relatively high number of casualties as compared to first wave. The literature lacks scientific reason behind this. Aims and Objectives: The present study aimed toward detection of mortality factors for COVID-19 patients from a Level 3 Medical College Hospital in both waves in Western UP District in India so as to find a better treatment strategies for COVID-19 patients for possible next 3rd COVID-19 wave. Materials and Methods: This study is aimed to find any difference in Wave 1 and 2 mortality factors among COVID-19 patients in a Level 3 Medical College Hospital in western up district Saharanpur in India from April 1, 2020 to Sep 30, 2021. Results: Although there were more number of deaths in Wave 2 (n=537) as compared to Wave 1 (n=172), deaths even after treatment of COVID-19 were more in wave 1 (72%) as compared to wave 2 (67.9%), but it was not statistically significant (P>0.05). In COVID -19, Wave 1 most of the patients were elderly (aged >60 years) (40.3%) whereas in Wave 2 45–60 years age group were more affected (40.5%). Presence of more than 2 comorbidities was also seen more in wave 1 (37.1%) as compared to Wave 2 (23.8%). In COVID-19, both Waves (1 and 2) the most common co-morbidity was Type2DM (52% and 36.4%, respectively), but DM was found to be more in COVID+ve patients of Wave 1 as compared to wave 2 COVID+ve patients whereas any CARDIAC abnormality co-morbidity was found more in Wave 2 patients as compared to Wave 1 (14.2% vs. 12.1%). Conclusion: Possibly COVID-19 virus operated differently at Cardio-respiratory system leading to increased mortality in COVID-19 patients in Wave 2.
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Cendani Goller, Astari Arum, Anak Agung Ayu Putri Laksmidewi, and Rindha Dwi Sihanto. "Characteristics of neurologic manifestations in COVID-19 patients at Sanglah Hospital, Denpasar, Indonesia." Romanian Journal of Neurology 21, no. 2 (2022): 162–68. http://dx.doi.org/10.37897/rjn.2022.2.12.
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Background/aim. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Although the main symptoms of this virus are in the respiratory system, neurological clinical manifestations in the form of the central nervous system (CNS), peripheral nervous system (PNS) and musculoskeletal system are often found. This study aims for data on the characteristics of neurological manifestations in COVID-19 patients. Research methods. A retrospective cohort study with medical record from June 2020 to June 2021 which was analyzed descriptive, Chi-Square test and survival using SPSS program. Research result. There were 136 patients with PCR swab results (+), 80 (58.8%) male and 56 (41.2%) female, age > 50 years 92 (67.6%), 47 (34.6%) died. Neurological manifestations in the CNS that stroke 72 (52.9%) RR 4.8 (CI 95% 2.1-10.6; p<0.001), seizures 19 (14%) RR 14.7 (95% CI 4-54.3; p <0.001), headache 32 (23.5%) RR 5.7 (95% CI 2, 4-13.4; p<0.001), encephalopathy 35 (25.7%) RR 41.1 (95% CI 12.7-132.7; p<0.001), in the PNS myasthenic crisis 6 (4.4%) RR 10.4 (95% CI 1.2-92.5; p = 0.035) anosmia 73 (53.7%) RR 0.2 (95% CI 0.1-0.5; p<0.001) while musculoskeletal myalgia 25 (18.4%) and low back pain 18 (13.2%) was not significant. Conclusion. Most neurological clinical manifestations in the CNS (stroke, headache, seizures and encephalopathy) followed by the PNS (myasthenia crisis and anosmia). Neuroinvasive complications are thought to play a role as one of the causes of respiratory failure and death in patients with COVID-19.
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Amodan, Bob O., Lilian Bulage, Elizabeth Katana, et al. "Level and Determinants of Adherence to COVID-19 Preventive Measures in the First Stage of the Outbreak in Uganda." International Journal of Environmental Research and Public Health 17, no. 23 (2020): 8810. http://dx.doi.org/10.3390/ijerph17238810.
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We conducted an online survey in the first two months of the Coronavirus Disease 2019 (COVID-19) epidemic in Uganda to assess the level and determinants of adherence to and satisfaction with the COVID-19 preventive measures recommended by the government. We generated Likert scales for adherence and satisfaction outcome variables and measured them with four preventive measures, including handwashing, wearing face masks, physical distancing, and coughing/sneezing hygiene. Of 1726 respondents (mean age: 36 years; range: 12–72), 59% were males, 495 (29%) were adherent to, and 545 (32%) were extremely satisfied with all four preventive measures. Adherence to all four measures was associated with living in Kampala City Centre (AOR: 1.7, 95% CI: 1.1–2.6) and receiving COVID-19 information from health workers (AOR: 1.2, 95% CI: 1.01–1.5) or village leaders (AOR: 1.4, 95% CI: 1.02–1.9). Persons who lived with younger siblings had reduced odds of adherence to all four measures (AOR: 0.75, 95% CI: 0.61–0.93). Extreme satisfaction with all four measures was associated with being female (AOR: 1.3, 95% CI: 1.1–1.6) and health worker (AOR: 1.2, 95% CI: 1.0–1.5). Experiencing violence at home (AOR: 0.25, 95% CI: 0.09–0.67) was associated with lower satisfaction. Following reported poor adherence and satisfaction with preventive measures, behavior change programs using health workers should be expanded throughout, with emphasis on men.
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Kabir, Md Humayun, Munshi Md Mojibur Rahman, AKM Musa Khan, Alamgir Rashid Chowdhury, and AT Shahrier Ahmed. "Presentation and Outcome of Acute Limb Ischaemia." Journal of Armed Forces Medical College, Bangladesh 14, no. 1 (2019): 59–61. http://dx.doi.org/10.3329/jafmc.v14i1.42724.
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Introduction: Outcome of acute limb ischaemia (ALI) is depends on the timely intervention. Delayed reperfusion of acute occlusive limb ischemia causes local and systemic serious consequences and is the main cause of morbidity and mortality in these patients.
 Objective: To identify the factors impeding the management and outcome of ALI in a tertiary level hospital.
 Materials and Methods: This cross sectional study evaluated reporting time and management of 42 patients with ALI between Jan 2016 to Jan 2018 in Combined Military Hospital Dhaka. Late presentation of ALI is defined as reporting of patient after 72 hours of symptoms. Time of presentation, Grades of ischemia, co-morbidities, morbidities and mortality were recorded.
 Results: During the study period, 42 patients were included, 25 female (59.5%) and 17 male (40.5%). Average age was 63 years (30 years – 87 years). 38 (90%) patients with lower limb ischaemia and 4 (10%) patients with upper limb ischaemia. 2 patients (4.7%) reported within 6 hours of symptom, 6 patients (14.3%) presented within 24 hours, 11 patients (26.3%) within 72 hours and 23 patients (54.7%) after 72 hours. On admission, 16 patients had grade III ischemia, 18 had grade IIb, 8 had grade IIa. 12 patients died (28.5%) and 19 (45%) patients had amputation. The risk factors of amputation were grade of ischemia, extremity (lower limb 45% vs. Upper limb 0%), age and co-morbidity.
 Conclusion: Late presentation of acute occlusive ischemia carries high morbidity and mortality. Lack of awareness and Negligence of symptoms delay the reporting time to hospital.
 Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 59-61
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Oninla, Samuel O., Akinyemi O. Fadugbagbe, Olumayowa A. Oninla, Olumayowa A. Oninla, Olayinka A. Otetubi, and Olayinka A. Otetubi. "Pattern of childhood morbidities and outcome of childhood admissions in a Nigerian public secondary healthcare facility." Annals of Health Research 4, no. 2 (2018): 162–73. http://dx.doi.org/10.30442/ahr.0402-8-19.
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Background: Patterns of morbidity and mortality in hospital populations are indicative of community health needs and can be useful in planning improved medical services. Objectives: To determine the morbidity, mortality and outcome patterns, and the average duration of hospital stay of admitted children in the public secondary healthcare facility. Methods: Available hospital records of children aged one month to 15years, admitted during a one year period (October 1, 2010, to September 30, 2011) were reviewed for relevant data such as age, gender, final diagnosis, outcomes and dates of admissions and discharges. Results: Of the 1,266 records reviewed, 57.6% children were males, 42.4% females (Z= -10.9458; p=0.0001) and 82.5% were aged under-five years. Infections accounted for 81.6% of the morbidities, with malaria (39.2%), gastroenteritis (15.2%), pneumonia (10.9%), severe anaemia (4.2%) and septicaemia (3.0%) being the top five conditions. The duration of admission ranged from less than 24hours to 30 days, with a mean of 3.2 (2.8) days. Nine hundred and ninety-eight (78.8%) children were discharged while 64 (5.1%) died; 85.9% of the deaths occurred among under-five children. Thirty-four (6.3%) out of 537 females and 30 (4.1%) out 729 males died (Z= 7.7374; p= 0.0001). The top three causes of mortality included malaria 26.6%, septicaemia 12.5% and pneumonia 10.9%. Fifty out of 59 deaths (84.7%) occurred within 72 hours and 7 (11.9%) in<24hours of admission. Conclusions: Male children were more vulnerable to diseases while mortality was significantly higher among females. Infections dominated the causes of childhood morbidity and mortality in the public secondary healthcare facility, with under-five children bearing the brunt.
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Winkel, Abigail Ford, Sigrid B. Tristan, Margaret Dow, et al. "A National Curriculum to Address Professional Fulfillment and Burnout in OB-GYN Residents." Journal of Graduate Medical Education 12, no. 4 (2020): 461–68. http://dx.doi.org/10.4300/jgme-d-19-00728.1.
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ABSTRACT Background Physician well-being is a priority in graduate medical education as residents suffer high rates of burnout. With complex stressors affecting the clinical environment, conflicting evidence exists as to whether a formal curriculum improves resident well-being. Objective We assessed the feasibility and impact of a national pilot of a yearlong wellness curriculum for obstetrics and gynecology (OB-GYN) residents. Methods The Council on Resident Education in Obstetrics and Gynecology Wellness Task Force developed a national multicenter pilot group of 25 OB-GYN programs to participate in a prospective cohort study. The curriculum included 6 interactive wellness workshops using uniform teaching materials delivered during didactic time. Prior to and following their participation in the curriculum, residents completed a survey containing demographic information and the Professional Fulfillment Index. Results Among 592 eligible participants, 429 (72%) responded to the pretest and 387 (65%) to the posttest. Average age of respondents was 29.1 years (range = 24–52 years) and included 350 (82%) women and 79 (18%) men. At baseline, 254 of 540 (47%) respondents met criteria for burnout, and 101 (23%) met criteria for robust professional fulfillment. Residents participated in an average of 3.9 workshops. While aggregate posttest scores did not differ from baseline, residents attending 4 to 6 workshops had improved rates of burnout (40% vs 50%, P = .017) and robust professional fulfillment (28% vs 20%, P &lt; .001) compared with those with lower attendance. Conclusions A wellness curriculum was a feasible addition to OB-GYN residency program curricula in programs across the country. Residents with higher attendance experienced improved professional fulfillment and less burnout.
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Kurkure, Purna Arun, Saroj Prasad Panda, Maya Prasad, and Savita Goswami. "Adolescent and young adult (AYA) survivors of childhood cancers: A challenge in after completion of therapy (ACT) clinic in resource-constrained country." Journal of Clinical Oncology 34, no. 3_suppl (2016): 19. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.19.
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19 Background: To assess the evaluation of late effects in childhood cancer survivors who have transitioned to AYA age group on longitudinal follow up in After Completion of Therapy (ACT) clinic at Tata Memorial Hospital, Mumbai. Methods: ACT clinic database was analyzed for childhood cancer survivors who have attained age 15-30 yrs at last follow up in the clinic for demographics, grade of late effects &pattern of follow up. Results: Of 1720 childhood cancer Survivors ( > , 2 yrs off therapy & disease free) registered in ACT clinic from Feb 91-Feb15, 976(56.7%) are in AYA group, M.F = 707/269 (2.6:1), Hematolymphoid : Solid tumours = 543/433 (1.3:1), Mumbai based: Non Mumbai = 306/670 (1:2.2).Median age at diagnosis 8 yrs, current median age 20 yrs, median duration of ACT clinic follow up is 6 yrs. At registration 448 (47%) had no late effects. 230(24%) had grade I, 81(8.4%) grade II 195 (20%) had grade III. Only 9(1%) had grade IV late effects which increased to 53 (6%) at last follow up due to recurrence & second neoplasia. Only 29(3%) were at low risk of developing potential late effects. 466(48.5%) were in intermediate risk & 48.5% (466) fell in high risk category requiring at least annual follow up. 72% of survivors registered in ACT clinic from 1991-2001 had stopped follow up as compared to 36% registered in subsequent decade (p < 0.01). Conclusions: AYA survivors of childhood cancers form major (56.7%) group in Long Term Follow up clinic. The increasing incidence of life threatening late effects on longitudinal follow up combined with statistically significant increasing trend of stopping follow up over period of time since ACT registration is alarming & calls for innovative approaches for maintaining good follow up through survivor centric approaches such as use of IT based communication technologies & formation of childhood cancer survivors support groups like Ugam.
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Richardson, Donald, Muhammad Faisal, Massimo Fiori, Kevin Beatson, and Mohammed Mohammed. "Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study." BMJ Open 11, no. 2 (2021): e043721. http://dx.doi.org/10.1136/bmjopen-2020-043721.
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ObjectivesAlthough the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.DesignA retrospective cross-sectional study.SettingTwo acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.ParticipantsAdult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.ResultsOut of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).ConclusionsThe index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.
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Golubeva, I. S., N. P. Yavorskaya, L. V. Ektova, et al. "ANTITUMOR ACTIVITY OF SOME DERIVATIVES OF INDOLO[2,3-A]CARBAZOLES N-GLYCOSIDES WITH XYLOSE CARBOHYDRATE RESIDUE." Russian Journal of Biotherapy 19, no. 4 (2020): 86–93. http://dx.doi.org/10.17650/1726-9784-2020-19-4-86-93.
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Introduction. The search for new antineoplastic agents in a series of indolo[2,3-a]-carbazole derivatives is an urgent and promising direction, since compounds with antitumor activity have been found in this class. In the chemical fusion laboratory, N.N. Blokhin National Medical Research Center оf the Ministry of Health of Russia has developed an original and effective method for the synthesis of glycosides of indolo[2,3-a]-pyrrolo[3,4-c]carbazoles, which makes it possible to synthesize derivatives of N-glycosides of indolo[2,3-a]carbazoles with different substituents in the heterocyclic parts including at the maleimide nitrogen atom and with different carbohydrate residues.The purpose of the study – the primary assessment of the antitumor activity of new derivatives of indolocarbazoles with a carbohydrate residue xylose in models of tumor growth mice.Materials and methods. The compounds studied at transplanted tumors of mice: the Lewis epidermoid carcinoma (LLC), colon cancer ACATOL, cervical cancer RSHM-5, breast adenocarcinoma CA-755. Studies were performed on immunocompetent mice: males and females of BDF1 hybrids (C57Bl/6 × DBA/2), females CBA/Lac and Balb/c. Compound solutions were prepared ex tempore and administered to the mice intraperitoneally at a dose of 60 mg/kg daily for five days. The antitumor effect was evaluated as to of tumor growth inhibition and increase of life span of the treated animals as compared with the control ones.Results. Eight compounds studied, containing D-xylose as a carbohydrate component and various substituents at the maleimide nitrogen atom, showed different degrees of antitumor activity. Two derivatives have been identified: N-[5,7-dioxo-12-(β-D-xylopyranosyl)-indole[2,3-a]pyrrolo[3,4-c]carbazol-6-il]benzamide (compound 4) and N-[5,7-dioxo-12-(β-D-xylopyranosyl)-5,7,12,13-tetrahydro-6H-indole[2,3-a]pyrrolo[3,4-c]carbazole-6-il]pyridin-2-carboxamide (compound 8), which showed high antitumor activity on 4 solid tumors of mice with a duration of effect of 12 days or more. The most pronounced antitumor effect was obtained in compounds 4 and 8 in RSHM-5 and Ca-755, tumor growth inhibition was amounted, respectively: in RSHM-5 – 68–82 % and 80–72 %; for Ca-755 – 57–62 % and 86–68 % (p <0.05).Conclusion. For further research, we chose the compound (N-[5,7-dioxo-12-(β-D-xilopiranosil)-5,7,12,13-tetrahydro-6H-indole[2,3-a] pyrrolo[3,4-c]carbazol-6-il]pyridin-2-carboxamide).
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Nagamori, Minako, Yoshihiro Hirata, and Soichiro Sameshima. "Influence of Hydrogen Sulfide in Fuel on Electric Power of Solid Oxide Fuel Cell." Materials Science Forum 544-545 (May 2007): 997–1000. http://dx.doi.org/10.4028/www.scientific.net/msf.544-545.997.
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Terminal voltage, electric power density and overpotential were measured for the solid oxide fuel cell with gadolinium-doped ceria electrolyte (Ce0.8Gd0.2O1.9, GDC), 30 vol% Ni-GDC anode and Pt cathode using a H2 fuel or biogas (CH4 47, CO2 31, H2 19 vol %) at 1073 K. Addition of 1 ppm H2S in the 3vol % H2O-containing H2 fuel gave no change in the open circuit voltage (0.79 - 0.80 V) and the maximum power density (65 - 72 mW/cm2). Furthermore, no reaction between H2S and Ni in the anode was suggested by the thermodynamic calculation. On the other hand, the terminal voltage and electric power density decreased when 1 ppm H2S gas was mixed with the biogas. After the biogas with 1 ppm H2S flowed into the anode for 8 h, the electric power density decreased from 125 to 90 mW/cm2. The reduced electric power density was also recovered by passing 3 vol % H2O-containing H2 fuel for 2 h.
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Small, Cliona, Sian Kneafsey, Aoife McFeely, Shane O'Hanlon, Marie Therese Cooney, and Rachael Doyle. "19 Hip Fracture Outcomes in the Frail Older Person." Age and Ageing 48, Supplement_3 (2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.11.
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Abstract Background Hip fractures in the older person are associated with significant morbidity and mortality. Screening patients for frailty and assessing baseline mobility and function may help predict poorer outcomes Methods All patients >/= 60 years old with a hip fracture admitted under the orthopaedic team between February 2016-February 2018 were included. We assessed clinical frailty score(CFS), zuckermann functional recovery score(FRS) and new mobility score(NMS) on admission and at 1 year. Outcomes assessed included mortality rates and nursing home(NH) admission rates Results 541 patients were included; 533 underwent surgery, 4 died preoperatively and 4 of the periprosthetic fracture cohort were treated conservatively. 33 patients lost to follow-up. Overall mortality was 24.7%(n=134) at one year. In the severely frail cohort (CFS7-9)(n=72); 47.2% mortality rate at 1 year. 20.8%(n=15) came from home, 2 of those were discharged to NH. In the moderately frail cohort (CFS 5-6)(n= 184), mortality rate was 30.4% at 1 year. 77.2%(n=142) were admitted from home and 8%(n=15) of this cohort were discharged to NH. In the non-frail subgroup (CFS 1-4)(n=211), mortality rate was 11.8%(n= 25)at 1 year, 97.1% (n=205) were admitted from home and 7.5%(n=11) of the cohort admitted from home were living in a NH at 1 year. Regarding FRS; compared to those without frailty(FRS>75), those with FRS 30-75 had a two-fold increased risk of one year mortality [OR: 2.16 (95% CI: 1.24 to 3.78)]. This increased to a nearly six-fold increased risk in those with severe frailty (FRS<30); [OR 5.73 (95%CI : 3.16 -10.41)]. This effect was independent of age. A dementia diagnosis independent of age and frailty is associated with 2.5 fold increased risk of NH/mortality at 1 year Conclusion All three tools (CFS, NMS, FRS) can accurately predict mortality and NH admission at 1 year. Patients with higher CFS and poor baseline functioning and mobility have poorer outcomes. CFS is a simple tool that can be documented on admission with a hip fracture and help inform discussions with patients and families regarding potential outcomes/prognosis.
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Ganaraja, Valakunja H., Kiran Polavarapu, Mainak Bardhan, et al. "Disease Progression and Mutation Pattern in a Large Cohort of LGMD R1/LGMD 2A Patients from India." Global Medical Genetics 09, no. 01 (2021): 034–41. http://dx.doi.org/10.1055/s-0041-1736567.
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AbstractCalpainopathy is caused by mutations in the CAPN3. There is only one clinical and genetic study of CAPN3 from India and none from South India. A total of 72 (male[M]:female [F] = 34:38) genetically confirmed probands from 72 independent families are included in this study. Consanguinity was present in 54.2%. The mean age of onset and duration of symptoms are 13.5 ± 6.4 and 6.3 ± 4.7 years, respectively. Positive family history occurred in 23.3%. The predominant initial symptoms were proximal lower limb weakness (52.1%) and toe walking (20.5%). At presentation, 97.2% had hip girdle weakness, 69.4% had scapular winging, and 58.3% had contractures. Follow-up was available in 76.4%, and 92.7% were ambulant at a mean age of 23.7 ± 7.6 years and duration of 4.5 years, remaining 7.3% became wheelchair-bound at 25.5 ± 5.7 years of age (mean duration = 13.5 ± 4.6), 4.1% were aged more than 40 years (duration range = 5–20). The majority remained ambulant 10 years after disease onset. Next-generation sequencing (NGS) detected 47 unique CAPN3 variants in 72 patients, out of which 19 are novel. Missense variants were most common occurring in 59.7% (homozygous = 29; Compound heterozygous = 14). In the remaining 29 patients (40.3%), at least one suspected loss of function variant was present. Common recurrent variants were c.2051–1G > T and c.2338G > C in 9.7%, c.1343G > A, c.802–9G > A, and c.1319G > A in 6.9% and c.1963delC in 5.5% of population. Large deletions were observed in 4.2%. Exon 10 mutations accounted for 12 patients (16.7%). Our study highlights the efficiency of NGS technology in screening and molecular diagnosis of limb-girdle muscular dystrophy with recessive form (LGMDR1) patients in India.
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Douvis, Stavros J. "Variable Practice in Learning the Forehand Drive in Tennis." Perceptual and Motor Skills 101, no. 2 (2005): 531–45. http://dx.doi.org/10.2466/pms.101.2.531-545.
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One of the most important factors that has occupied researchers in motor learning is the method of practicing motor skills. This study examined the effect of variable practice in learning the forehand drive in tennis by children and adolescents. Variability of practice was achieved by the alternation of targets and the distance between the point of execution and the target. 40 male children ages 9 to 10 years and 40 male students ages 18 to 19 years were divided into eight equal groups according to age and training group (No Specific target, 1 target, 4 targets, and 5 targets). After 18 practice sessions over 40 days and similar teaching, the participants performed 60 transfer trials after a rest of 72 hours. The experimental design used was a 2 (age) × 4 (practice group) × 6 (block of trials) with repeated measures on the last factor for absolute and constant error scores. The analysis of variance showed that the children performed more poorly than the adolescents, and variable practice yielded better performance than constant and specialized practice. The results support the variability of practice hypothesis and indicate that the effect of variable and specialized practic was related to age of the groups of trainees.
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Lal, Roshan, Rajesh K. Bhawani, Santosh K. Dheer, Nitesh Kumar, and Soni Kumar. "Profile of COVID-19 patients in COVID dedicated tertiary care centre in Himachal Pradesh: a prospective observational cross sectional study." International Journal of Research in Medical Sciences 9, no. 11 (2021): 3284. http://dx.doi.org/10.18203/2320-6012.ijrms20214410.
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Background: COVID-19 pandemic originated in China in December 2019 and fumed in whole world over few months. Millions of deaths have occurred worldwide till now because of this pandemic. Causative agent was identified as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) causing viral pneumonia and serious manifestations were seen in association with increased age and comorbidies.Methods: This study was planned in very initial stage of pandemic in our country to study the profile of COVID-19 patients. This study was conducted over a period of six months from April 2020 to September 2020 at SLBSGMCH, Mandi at Nerchowk.Results: 202 patients were enrolled for this study with mean age of presentation 48 years, 61 were females, 147 (72%) were senior citizens, most patients were from district Mandi and most common symptoms were fever (58%), cough (46%), shortness of breath (35%) and associated commonest comorbidities were hypertension (HTN) (29%) and diabetes (23%). Median neutrophil to lymphocyte ratio (NLR) was higher (5.47) in moderate to severe disease and associated with poor outcome. All the 11 patients who were put on support of ventilator, succumbed to death.Conclusions: Most common symptoms were fever, cough, shortness of breath and most common comorbidty was HTN. Comorbidity, increased age and higher NLR were risk factors for severity and poor outcome. More research is needed to save mankind from this pandemic as still no specific therapy is available against this virus.
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Marrodan, I., E. Azkona, S. Carrera, et al. "Preoperative chemoradiotherapy with capecitabine and oxaliplatin in patients with locally advanced rectal cancer." Journal of Clinical Oncology 29, no. 4_suppl (2011): 548. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.548.
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548 Background: Locally advanced rectal carcinoma is associated with high rate of abdomino-perineal amputation. We analyzed a cohort of patients (pts) diagnosed of locally advanced rectal cancer, treated with neoadjuvant chemoradiotherapy (QT-RT) with capecitabine and oxaliplatin (XELOX) followed by four cycles of adjuvant XELOX after surgery. Methods: Patients with locally advanced rectal cancer (T3-T4 and/or N+) were treated with oxaliplatin (50mg/m2 day 1, 8, 22 and 29) and capecitabine (1,650mg/m2 on days 1 to 14 and 22 to 35) combined with pelvic radiotherapy (180 cGy/day; 45Gy in 25 fractions). Surgery was scheduled 4 to 6 weeks after completion QT-RT. Four cycles of adjuvant XELOX were administered (capecitabine 2,000mg/m2 on days 1 to 14 and oxaliplatin 130mg/m2 on day 1) every 3 weeks. Main end points assessed were: rate of sphincter preservation, pathologic complete response (pCR) rate and the feasibility of postoperative chemotherapy. Results: From March 2007 to April 2010, 98 pts with locally advanced rectal cancer were included. M/F: 66/32; ECOG 0/1: 19/79; median age: 64 (38-81); upper/mid/distal rectum: 13/50/35; clinical stage: cT3/N- 9, cT2-T3/N+ 72, cT4/N- 4, cT4/N+ 13. Full dose of preoperative QT-RT was administered in 93 pts (95%). Main toxicities were grade 1/2 neurotoxicity (56/4) and grade 2/3 diarrhea (23/10). After treatment 96 pts underwent surgery. Sphincter preservation, R0 resections and pCR were achieved in 57, 93 pts and 17 (18%) patients, respectively, and 65 pts (66%) received all 4 cycles of adjuvant XELOX. Grade 3/4 toxicities included diarrhea 3/0, vomiting 2/0, neurotoxicity 5/0, hand-foot syndrome 1/0, neutropenia 4/0 and thrombopenia 0/4. 3-year progression-free and overall survival were 66% and 72%, respectively. No toxic deaths were reported. Downstaging in T/N stage was achieved in 53/71 pts (55/74%) respectively. Conclusions: Combination preoperative QT-RT with capecitabine and oxaliplatin is a well tolerated regimen and achieves encouraging rates of pCR, R0 resection, sphincter preservation and tumor downstaging in patients with locally advanced rectal cancer. No significant financial relationships to disclose.
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Mudge, Alison M., Carol Douglas, Xanthe Sansome, et al. "Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study." BMJ Supportive & Palliative Care 8, no. 2 (2018): 213–20. http://dx.doi.org/10.1136/bmjspcare-2017-001441.
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ObjectivesPeople with serious life-limiting disease benefit from advance care planning, but require active identification. This study applied the Gold Standards Framework Proactive Identification Guidance (GSF-PIG) to a general hospital population to describe high-risk patients and explore prognostic performance for 12-month mortality.MethodsProspective cohort study conducted in a metropolitan teaching hospital in Australia. Hospital inpatients on a single day aged 18 years and older were eligible, excluding maternity and neonatal, mental health and day treatment patients. Data sources included medical record and structured questions for medical and nursing staff. High-risk was predefined as positive response to the surprise question (SQ) plus two or more SPICT indicators of general deterioration. Descriptive variables included demographics, frailty and functional measures, treating team, advance care planning documentation and hospital utilisation. Primary outcome for prognostic performance was 12-month mortality.ResultsWe identified 540 eligible inpatients on the study day and 513 had complete data (mean age 60, 54% male, 30% living alone, 19% elective admissions). Of these, 191 (37%) were high-risk; they were older, frailer, more dependent and had been in hospital longer than low-risk participants. Within 12 months, 92 participants (18%) died (72/191(38%) high-risk versus 20/322(6%) low-risk, P<0.001), providing sensitivity 78%, specificity 72%, positive predictive value 38% and negative predictive value 94%. SQ alone provided higher sensitivity, adding advanced disease indicators improved specificity.ConclusionsThe GSF-PIG approach identified a large minority of hospital inpatients who might benefit from advance care planning. Future studies are needed to investigate the feasibility, cost and impact of screening in hospitals.
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Girina, A. A., F. I. Petrovskiy, N. V. Sosykina, and A. L. Zaplatnikov. "Evaluation of the Incidence of Rotavirus Infection and the Effectiveness of Vaccination in the Khanty-Mansi Autonomous Ugra District in 2014–2018." Epidemiology and Vaccinal Prevention 19, no. 2 (2020): 95–101. http://dx.doi.org/10.31631/2073-3046-2020-19-2-95-101.
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Relevance. Rotavirus infection (RVI) is recognized as the main cause of severe gastroenteritis in children worldwide and leads to 527 000 deaths annually.Aim. Present study was intended to evaluate the effectiveness of anti-epidemic measures and vaccination against RVI in children in Pyt-Yakh, Khanty-Mansiysk Autonomous Okrug-Ugra in 2016–2017.Materials and methods. An analysis of the incidence of intestinal infection and RVI was carried out within 2 years prior (2014–2015) to and 2 years after (2016–2017) the implementation of anti-epidemic measures.A separate study was conducted to evaluate the safety and efficacy of a live oral pentavalent vaccine in 593 children including 433 who received three doses of the vaccine in 2016–2017.Results. It was shown that anti-epidemic measures including vaccination decreased the chances of RVI in children aged 0–17 years 1.68 fold in 2017–2018 compared to 2015–2016 (odds ratio (OR) 0.59, 95% confidence interval (CI) 0.49–0.71, p < 0.001). The same data were obtained for children 12 months and younger (OR 0.57, 95% CI 0.35–0.95, р = 0.037) and children aged 1–2 years old (OR 0.62, 95% CI 0.45–0.84, р = 0.002). There were no cases of moderate or severe intestinal infections or hospitalizations in vaccinated population as well as postvaccinal complications.Conclusion. The incidence of intestinal and rotavirus infections in all population in 2018 compared to 2016decreased by 53% and 72% respectively.
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Muñoz, Patricia, Alicia Galar, Pilar Catalán, et al. "The first 100 cases of COVID-19 in a Hospital in Madrid with a 2-month follow-up." Revista Española de Quimioterapia 33, no. 5 (2020): 369–78. http://dx.doi.org/10.37201/req/072.2020.
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Background. There are few descriptions of the clinical presentation and evolution of consecutive SARS-CoV-2 infections with a long-enough follow up. Methods. Description of the first consecutive 100 patients with microbiologically-proven COVID-19 in a large hospital in Madrid, Spain including a minimum of two-month follow up. Results. The median age of the patients (52% males) was 61.5 years (IQR=39.5-82.0) and the median BMI was 28.8 kg/m2 (IQR=24.7-33.7). Overall 72% of the patients had one or more co-morbid conditions with a median age-adjusted Charlson index of 2 (IQR=0-5.7). Five patients (5%) were immunosuppressed. The most common symptoms at the time of diagnosis were fever (80.0%), cough (53.0%) and dyspnea (23.0%). The median O2 saturation at the time of first examination was 94% (IQR=90-97). Chest X-ray on admission was compatible with pneumonia in 63% of the cases (bilateral in 42% and unilateral in 21%). Overall, 30% were managed at home and 70% were admitted to the hospital. Thirteen patients were admitted to the ICU with a median of 11 days of stay in the Unit (IQR=6.0-28.0). CALL score of our population ranged from 4 to 13. Overall, 60.0% of patients received antibiotic treatment and 66.0%, empirical antiviral treatment, mainly with lopinavir/ritonavir (65%) or hydroxychloroquine (42%). Mortality, with a minimum of 60 days of follow up, was 23%. The median age of the deceased patients was 85 years (IQR=79-93). Conclusions. We found a high mortality in the first 100 patients diagnosed with COVID-19 at our institution, associated with advanced age and the presence of serious underlying diseases.
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Allen, Ann Taylor. "Preußens Ruhm und Deutschlands Ehre: Zum nationalen Ehrdiskurs im Vorfeld der preußisch-französischen Kriege des 19. Jahrhunderts. By Birgit Aschmann. Beiträge zur Militärgeschichte, volume 72. Edited by Militärgeschichtliches Forschungsamt.Munich: Oldenbourg, 2013. Pp. xii+548. €49.80." Journal of Modern History 87, no. 1 (2015): 153–55. http://dx.doi.org/10.1086/680073.
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Sawitri, Harvina, and Nora Maulina. "PERSEPSI DOKTER MUDA DALAM MENGHADAPI WABAH CORONAVIRUS DISEASE (COVID-19) DI BLUD RUMAH SAKIT CUT MEUTIA TAHUN 2020." AVERROUS: Jurnal Kedokteran dan Kesehatan Malikussaleh 7, no. 1 (2021): 1. http://dx.doi.org/10.29103/averrous.v7i1.3227.
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AbstrakCoronavirus merupakan keluarga besar virus yang menyebabkan penyakit ringan sampai berat, seperti common cold atau pilek dan penyakit yang serius seperti MERS dan SARS. Gejalanya demam, batuk, dan sesak napas yang membutuhkan perawatan di RS. Orang yang lebih tua dan memiliki masalah medis mendasar seperti penyakit kardiovaskular, diabetes, penyakit pernapasan kronis, dan kanker lebih berisiko untuk mengalami penyakit yang serius. Kasus coronavirus pertama kali ditemukan di Cina. Setelah itu, dalam beberapa minggu, virus ini menyebar ke seluruh bagian negara Cina dan dalam kurun waktu 1 bulan menyebar ke negara lainnya, termasuk Italia, Amerika Serikat, dan Jerman hingga ke Asia. Kematian akibat virus ini telah mencapai 580.045 kasus. Tingkat kematian akibat penyakit ini mencapai 4-5% dengan kematian terbanyak terjadi pada kelompok usia di atas 65 tahun. Tenaga medis berperan penting menolong pasien di rumah sakit, klinik dan tempat medis lainnya. Semua tenaga medis termasuk dokter, perawat dan bidan serta dokter muda akan mengorbankan waktu, pikiran dan tenaga untuk memerangi penyebaran virus. Seluruh tenaga medis dari berbagai profesi dan kelompok yang terlibat dalam merawat pasien akan sangat mudah tertular coronavirus. Penelitian ini bertujuan mengetahui Persepsi (termasuk pengetahuan dan sikap) dokter muda dalam menghadapi wabah Coronavirus. Penelitian dilakukan di Rumah Sakit Cut Meutia pada tahun 2020 dengan menggunakan rancangan penelitian Cross-Sectional dan metode sampling Purposive Sampling. Hasil penelitian menunjukkan sebagian besar dokter muda mempunyai pengetahuan yang baik (67%), sikap yang baik (68%) dan persepsi yang baik (72%) dalam menghadapi pandemi COVID-19 ditempat pendidikannya. Namun masih banyak persepsi yang salah tentang virus COVID-19 seperti masih terpengaruh dengan postingan media sosial (54,7%), terpengaruh dengan perbincangan pandemi virus Corona di media massa (50,7%) dan 34,7 % menganggap anda virus COVID-19 adalah senjata biologi.
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Bajema, Kristina L., Xiao Qing Wang, Denise M. Hynes, et al. "Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022." JAMA Network Open 5, no. 11 (2022): e2241434. http://dx.doi.org/10.1001/jamanetworkopen.2022.41434.
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ImportanceOlder adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19–related hospitalization and death have been authorized for use.ObjectiveTo describe factors associated with receipt of outpatient COVID-19 pharmacotherapies in the Veterans Affairs (VA) health care system.Design, Settings, and ParticipantsThis cohort study assessed outpatient veterans with risk factors for severe COVID-19 who tested positive for SARS-CoV-2 during January and February 2022. The setting was the VA health care system, the largest integrated health care system in the US.ExposuresDemographic characteristics, place of residence, underlying medical conditions, and COVID-19 vaccination.Main Outcomes and MeasuresThe odds of receipt of any COVID-19 pharmacotherapy, including sotrovimab, nirmatrelvir boosted with ritonavir, molnupiravir, or remdesivir were estimated using multivariable logistic regression.ResultsAmong 111 717 veterans included in this study (median [IQR] age, 60 [46-72] years; 96 482 [86.4%] male, 23 362 [20.9%] Black, 10 740 [9.6%] Hispanic, 75 973 [68.0%] White) who tested positive for SARS-CoV-2 during January to February 2022, 4233 (3.8%) received any COVID-19 pharmacotherapy, including 2870 of 92 396 (3.1%) in January and 1363 of 19 321 (7.1%) in February. Among a subset of 56 285 veterans with documented COVID-19–related symptoms in the 30 days preceding a positive SARS-CoV-2 test, 3079 (5.5%) received any COVID-19 pharmacotherapy. Untreated veterans had a median (IQR) age of 60 (46-71) years and a median (IQR) of 3 (2-5) underlying medical conditions. Veterans receiving any treatment were more likely to be older (aged 65 to 74 years vs 50 to 64 years: adjusted odds ratio [aOR], 1.66 [95% CI, 1.52-1.80]; aged at least 75 years vs 50 to 64 years: aOR, 1.67 [95% CI, 1.53-1.84]) and have a higher number of underlying conditions (at least 5 conditions vs 1 to 2 conditions: aOR, 2.17 [95% CI, 1.98-2.39]). Compared with White veterans, Black veterans (aOR, 0.65 [95% CI, 0.60-0.72]) were less likely to receive treatment; and compared with non-Hispanic veterans, Hispanic veterans (aOR, 0.88 [95% CI, 0.77-0.99]) were less likely to receive treatment. There were 16 546 courses of sotrovimab, nirmatrelvir, and molnupiravir allocated across the VA during this period.Conclusions and RelevanceIn this cohort study of veterans who tested positive for SARS-CoV-2 during January and February when supply of outpatient COVID-19 pharmacotherapies was limited, prescription of these pharmacotherapies was underused, and many veterans with risk factors for severe COVID-19 did not receive treatment. Veterans from minority racial and ethnic groups were less likely to receive any pharmacotherapy.
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Nasseh, Jessica, Céline Podevin, Camille Ternynck, et al. "Self-reported Impact of the Early 2020 COVID-19 Crisis on the Healthcare Pathway During and After Lockdown in Patients With Chronic Immune-Mediated Inflammatory Diseases: A Practical Survey." Journal of Patient Experience 9 (January 2022): 237437352211437. http://dx.doi.org/10.1177/23743735221143736.
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Introduction: Global lockdown in the context of the coronavirus disease 2019 (COVID-19) pandemic is an unprecedented experience. We report here the results of an anonymous questionnaire-based survey on the healthcare and control of chronic IMIDs (chronic immune-mediated inflammatory diseases) within the IMMINENT network during the French lockdown (March 17, 2020-May 11, 2020) and the 2-month period following the end of the lockdown (July 11, 2020). Methods: Two anonymous questionnaires were sent by email to 4500 patients who were followed in a university hospital for an IMID in the departments of gastroenterology, rheumatology, dermatology, pneumology, neurology, and internal medicine. Results: A total of 921/4500 (20.46%) responded to the first survey (impact of the lockdown), and 553/4500 (12.28%) to the second (impact at 2-months post-lockdown). Concerning the impact of the lockdown, 420/915 (45.9%) reported affected follow-up. Similarly, after the lockdown, 248/544 (45.6%) declared a negative impact on their follow-up. The repartition by departments of patients’ perception of an altered follow-up during ( P = .72) and at the end of the lockdown ( P = .77) was not statistically different. Our study highlighted the effects of the COVID-19 pandemic and the restriction measures implemented on the self-reported impact felt by patients on the follow-up of their chronic IMIDs without significant differences among all departments. Conclusion: Our study is original by showing that patients, whatever the type of IMID, shared this same negative perception. This transdisciplinary study demonstrated the importance of a collaborative network among all departments.
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Nagarakanti, Sandhya, Eliahu Bishburg, Donna George, and Kristen Ehlers. "874. Impact of Telehealth in HIV Ambulatory Clinic during COVID-19 Pandemic Impact of Telehealth in HIV Ambulatory Clinic during COVID-19 Pandemic." Open Forum Infectious Diseases 8, Supplement_1 (2021): S528—S529. http://dx.doi.org/10.1093/ofid/ofab466.1069.
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Abstract Background HIV outpatient in-person (IN-P) visits were limited during the COVID-19 pandemic, and most patients (pts) were cared for remotely through telehealth (TELE). We sought to evaluate the impact of TELE on HIV infected pts during the pandemic compared to the pre-pandemic IN-P care. Methods Retrospective chart review of pts in an outpatient HIV clinic, study period 03/30/2019 to 03/29/2021. Two periods were defined: pre-COVID (Pre-CO) 3/30/2019 to 3/29/2020 and COVID (CO) 3/30/2020 to 3/29/2021. Data was collected on demographics, HIV risk, type of encounter, number of encounters, CD4, HIV Viral loads (VL) at first, and last visit, treatment regimen information. HIV VL &lt; 200 copies/ml was considered as undetectable. Results A total of 607 pts were evaluated. Mean age 51years; (Range-20-84). Male 306 (50.4%), African American 545(90%), Hispanic 50 (8.2%), white 9 (1.5%), Asian 3(0.5%). HIV risk: heterosexual 437(72%), male sex with male 118(19.4%), intravenous drug use 8 (1.3%). In the Pre-CO period, 530 pts were seen as IN-P; in the CO period 606 pts were encountered of which 304 (50.2%) were TELE visits, 89(14.7%) IN-P, 213(35%) had both TELE and IN-P encounters. Mean number of encounters were 2.59 in the Pre-CO and 2.46 during CO. The number of new pts in the Pre-CO were 36 (7%) vs. 52(8.6%) in the CO (p=0.26). During the pre-CO, 373 pts had CD4 measured at first and last visits, 353(95%) at the first visit and 352 (94.3%) at the last visit had CD4 counts ≥ 200/uL (p=.87); 373 pts had a VL done at first and last visits, 330 (88.5%) at the first visit and 337(90.3%) at last visit were undetectable (p=0.41). During CO, 445 pts had CD4 measured at first and last visits, 402 (90.3%) at the first visit and 445(94.2%) at the last visit had CD4 count ≥200/uL (p=0.03); 448 pts had VL measured at first and last encounters, 389(87%) at the first visit and 417(93%) in the last visit were undetectable (p=0.002). Antiretroviral changes occurred in 29% in the Pre-Co compared to 19% in the CO (p=0 .32). Conclusion In our clinic, more pts were cared for during the CO period compared to the Pre-CO period. Significantly, more pts had undetectable HIV VL during CO period. At least one TELE visit was utilized by over ¾ of the pts. TELE has a potentially important role in future HIV care without compromising patient outcomes. Disclosures All Authors: No reported disclosures
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Owens, Lisa A., Niamh Phelan, and Lucy Ann A. Behan. "The Impact of the Covid-19 Pandemic on Women’s Reproductive Health." Journal of the Endocrine Society 5, Supplement_1 (2021): A735—A736. http://dx.doi.org/10.1210/jendso/bvab048.1496.
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Abstract Background: The Covid-19 pandemic has profoundly affected the lives of the global population. It is known that periods of stress and psychological distress can affect women’s menstrual cycles. We, therefore, performed an observational study of women’s reproductive health over the course of the pandemic. Materials & Methods: An anonymous digital survey was shared by the authors via social media in September 2020. All women of reproductive age were invited to complete the survey. Results: 1031 women completed the survey. The mean age was 36.7 ± 6.6 years. 693/70% reported recording their cycles using an app or diary. 233/23% were using hormonal contraception. 441/46% reported a change in their menstrual cycle since the beginning of the pandemic. 483/53% reported worsening premenstrual symptoms, 100/18% reported new menorrhagia (p=0.003) and 173/30% new dysmenorrhea (p&lt;0.0001) compared to before the pandemic. 72/9% reported missed periods who not previously missed periods (p=0.003) and the median number of missed periods was 2 (IQR 1-3). 17/21% of those who ‘occasionally’ missed periods pre-pandemic missed periods ‘often’ during the pandemic. 467/45% reported a reduced libido. There was no change in the median cycle length (28 days) or days of bleeding (5) but there was a wider variability of cycle length (p=0.01) and a 1-day median decrease in the minimum (p&lt;0.0001) and maximum (p=0.009) cycle length. Women reported a median 2kg increase in self-reported weight and a 30-minute increase in median weekly exercise. 517/50% of women stated that their diet was worse and 232/23% that it was better than before the pandemic. 407/40% reported working more and 169/16% were working less. Women related a significant increase in low mood (p&lt;0.0001), poor appetite (p&lt;0.0001), binge eating (p&lt;0.0001), poor concentration (p&lt;0.0001), anxiety (p&lt;0.0001), poor sleep (p&lt;0.0001), loneliness (p&lt;0.0001) and excess alcohol use (p&lt;0.0001). Specific stressors reported included work stress (499/48%), difficulty accessing healthcare (254/25%), change in financial (201/19%) and living (169/16%) situation, difficulties with homeschooling children (191/19%), family or partner conflict (170/16%), family illness or bereavement (156/15%), and difficulties accessing or providing childcare (99/10%). Conclusions: The Covid-19 pandemic has significantly impacted the reproductive health of women. The long term health implications of this are yet to be determined and future studies should address this.
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Szewczyk, Mateusz, Andrzej Marszałek, Paweł Golusiński, et al. "Does experience affect surgical margins in head and neck basal cell carcinoma?" Otolaryngologia Polska 76, no. 2 (2022): 1–5. http://dx.doi.org/10.5604/01.3001.0015.7117.
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Purpose: The aim of our study was to evaluate the impact of surgical experience in a high volume head and neck surgery department on basal cell carcinoma margin status. Methods: A retrospective analysis of 546 patients surgically treated for primary basal cell carcinoma of the head and neck region was done. Resections were performed by 4 specialists with equal experience in head and neck surgery and 4 ENT residents at the same level of surgical training. A margin of 3-5mm was chosen, according to guidelines. Results: The study consisted of 304 males and 242 females, mean age of 69 (range 26 – 100). Most of the tumors were located on the nose (165 pts; 30,2%) and auricle (119; 21,7%). The most common histological subtype was nodular (119; 21,7%). Tumor size was up to 20mm in 394 cases (72%). Positive surgical margins were found in 112 cases (20,5%). There was no difference in terms of positive surgical margins between residents (19/119 cases; 15,9%) and specialists (93/426; 21,8%; p=0.161). Conclusions: The results of our study have shown that adequate surgical training in dedicated head and neck surgery department is an efficient factor in obtaining free surgical margins in head and neck basal cell carcinoma.
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Kulvatunyou, Narong, Peter M. Rhee, Steven N. Carter, et al. "Defining Incidence and Outcome of Contrast-Induced Nephropathy Among Trauma: Is It Overhyped?" American Surgeon 77, no. 6 (2011): 686–89. http://dx.doi.org/10.1177/000313481107700620.
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Contrast-induced nephropathy (CIN) in trauma patients is uncommon and the incidence is unknown. We studied the incidence of CIN and its outcome. A retrospective chart review of trauma patients 16 years of age and older who were admitted to our Level I trauma center during 2005 was performed. Patients who received the intravenous contrast CT scan and had their serum creatinine (Cr) monitored at admission and at 48 to 72 hours were identified. CIN was defined as a 0.5-mg/dL rise of serum Cr or a 25 per cent increase from the baseline if the baseline Cr was abnormal. We excluded patients transferred from an outside facility, patients without repeated serum Cr measurements, patients who had cardiac arrest or persistent hypotension, and patients who had received N-acetylcysteine (Mucomyst) before their CT scan. We compared CIN and non-CIN groups. During 2005, 543 fit our study criteria, of whom 19 (3.5%) had CIN. CIN (vs non-CIN) had a higher baseline serum Cr (1.48 + 0.23 vs 1.06 + 0.02, P < 0.001), a longer intensive care unit stay (17 vs 5 days, P < 0.001), and a longer hospital stay (19 vs 8 days, P < 0.001); the mortality rate was not different (10 vs 4%, P = 0.2). We found elevated baseline serum Cr (OR, 1.92; 95% CI, 1.13 to 3.27; P = 0.016) to be associated with increased risk for CIN. All but two serum Cr levels peaked within 48 hours; all returned to baseline. One patient with an underlying congenital kidney disease required temporary dialysis. CIN incidence in trauma is low and the clinical course is benign.
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Schrag, Stephanie J., Jennifer R. Verani, Brian E. Dixon, et al. "Estimation of COVID-19 mRNA Vaccine Effectiveness Against Medically Attended COVID-19 in Pregnancy During Periods of Delta and Omicron Variant Predominance in the United States." JAMA Network Open 5, no. 9 (2022): e2233273. http://dx.doi.org/10.1001/jamanetworkopen.2022.33273.
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ImportancePregnant people are at high risk for severe COVID-19 but were excluded from mRNA vaccine trials; data on COVID-19 vaccine effectiveness (VE) are needed.ObjectiveTo evaluate the estimated effectiveness of mRNA vaccination against medically attended COVID-19 among pregnant people during Delta and Omicron predominance.Design, Setting, and ParticipantsThis test-negative, case-control study was conducted from June 2021 to June 2022 in a network of 306 hospitals and 164 emergency department and urgent care (ED/UC) facilities across 10 US states, including 4517 ED/UC encounters and 975 hospitalizations among pregnant people with COVID-19–like illness (CLI) who underwent SARS-CoV-2 molecular testing.ExposuresTwo doses (14-149 and ≥150 days prior) and 3 doses (7-119 and ≥120 days prior) of COVID-19 mRNA vaccine (≥1 dose received during pregnancy) vs unvaccinated.Main Outcomes and MeasuresEstimated VE against laboratory-confirmed COVID-19–associated ED/UC encounter or hospitalization, based on the adjusted odds ratio (aOR) for prior vaccination; VE was calculated as (1 − aOR) × 100%.ResultsAmong 4517 eligible CLI-associated ED/UC encounters and 975 hospitalizations, 885 (19.6%) and 334 (34.3%) were SARS-CoV-2 positive, respectively; the median (IQR) patient age was 28 (24-32) years and 31 (26-35) years, 537 (12.0%) and 118 (12.0%) were non-Hispanic Black and 1189 (26.0%) and 240 (25.0%) were Hispanic. During Delta predominance, the estimated VE against COVID-19–associated ED/UC encounters was 84% (95% CI, 69% to 92%) for 2 doses within 14 to 149 days, 75% (95% CI, 5% to 93%) for 2 doses 150 or more days prior, and 81% (95% CI, 30% to 95%) for 3 doses 7 to 119 days prior; estimated VE against COVID-19–associated hospitalization was 99% (95% CI, 96% to 100%), 96% (95% CI, 86% to 99%), and 97% (95% CI, 79% to 100%), respectively. During Omicron predominance, for ED/UC encounters, the estimated VE of 2 doses within 14 to 149 days, 2 doses 150 or more days, 3 doses within 7 to 119 days, and 3 doses 120 or more days prior was 3% (95% CI, −49% to 37%), 42% (95% CI, −16% to 72%), 79% (95% CI, 59% to 89%), and −124% (95% CI, −414% to 2%), respectively; for hospitalization, estimated VE was 86% (95% CI, 41% to 97%), 64% (95% CI, −102% to 93%), 86% (95% CI, 28% to 97%), and −53% (95% CI, −1254% to 83%), respectively.Conclusions and RelevanceIn this study, maternal mRNA COVID-19 vaccination, including booster dose, was associated with protection against medically attended COVID-19. VE estimates were higher against COVID-19–associated hospitalization than ED/UC visits and lower against the Omicron variant than the Delta variant. Protection waned over time, particularly during Omicron predominance.