Nevin Manimala

Dermatitis. 2021 Sep 27. doi: 10.1097/DER.0000000000000709. Online ahead of print.

ABSTRACT

BACKGROUND: Ethylhexylglycerin (EHG) is a recently recognized contact allergen.

OBJECTIVE: The aims of the study were to characterize individuals with positive patch test reactions to EHG and to analyze reaction strength, clinical relevance, and allergen sources.

METHODS: This study was a retrospective analysis of the patients patch tested to EHG (5% petrolatum) by the North American Contact Dermatitis Group (2013-2018).

RESULTS: Of 15,560 patients tested to EHG, 39 (0.25%) had positive (final interpretation of “allergic”) reactions. Most were female (71.8%) and/or older than 40 years (76.9%). There were no statistically significant differences between age, sex, or atopic history when compared with EHG-negative patients. The most common anatomic sites of dermatitis were the face (28.2%) and scattered generalized distribution (25.6%). Most EHG-positive reactions were + (35.9%) or ++ (33.3%). Current clinical relevance was high (79.5%); none, however, were related to occupation. Personal care products were the most common source of exposure to EHG (59.0%).

CONCLUSIONS: Ethylhexylglycerin is a rare contact allergen; the positive frequency of 0.25% is similar to other low allergenic preservatives including parabens, benzyl alcohol, and phenoxyethanol. The patch test concentration of 5.0% seems to be nonirritating. Although relatively uncommon, EHG reactions were usually clinically relevant (79.5%), often because of moisturizers/lotions/creams.

PMID:34570737 | DOI:10.1097/DER.0000000000000709

Dermatitis. 2021 Sep 27. doi: 10.1097/DER.0000000000000787. Online ahead of print.

ABSTRACT

BACKGROUND: Recently, aluminum chloride hexahydrate (ACH) 10.0% petrolatum (pet) was recommended for patch testing to detect aluminum contact allergy. Aluminum lactate (AL) may be as reliable a test substance as ACH.

OBJECTIVE: We aimed to investigate the frequencies of aluminum allergy when ACH and AL were used in patch testing consecutive patients.

METHODS: Petrolatum preparations of ACH 10.0% and AL 12.0% were added to the baseline series in 2010-2017. Aluminum chloride hexahydrate 10.0% pet was added to the children baseline series from July 1, 2012, to December 31, 2017.

RESULTS: A total of 5448 patients were patch tested with the extended baseline series and 196 children with the extended children baseline series. Forty-eight of the 5448 adults (0.9%) and 10 of the 196 children (5.1%) were diagnosed with aluminum contact allergy. A significant difference was found between the aluminum allergy frequencies in children and adults patch tested with ACH in 2013-2017 (P < 0.001). The difference between the frequencies of contact allergies for the 2 aluminum salts is not statistically significant.

CONCLUSIONS: Patch testing with ACH and AL demonstrated similar contact allergy frequencies. To detect aluminum allergy, patch testing with ACH 10.0% pet is recommended. Aluminum chloride hexahydrate 10.0% pet should be considered for inclusion in baseline series for patch testing adults and children.

PMID:34570735 | DOI:10.1097/DER.0000000000000787

Elife. 2021 Sep 27;10:e64505. doi: 10.7554/eLife.64505.

ABSTRACT

Representations related to past experiences play a critical role in memory and decision-making processes. The rat hippocampus expresses these types of representations during sharp-wave ripple (SWR) events, and previous work identified a minority of SWRs that contain ‘replay’ of spatial trajectories at ∼20x the movement speed of the animal. Efforts to understand replay typically make multiple assumptions about which events to examine and what sorts of representations constitute replay. We therefore lack a clear understanding of both the prevalence and the range of representational dynamics associated with replay. Here, we develop a state space model that uses a combination of movement dynamics of different speeds to capture the spatial content and time evolution of replay during SWRs. Using this model, we find that the large majority of replay events contain spatially coherent, interpretable content. Furthermore, many events progress at real-world, rather than accelerated, movement speeds, consistent with actual experiences.

PMID:34570699 | DOI:10.7554/eLife.64505

Elife. 2021 Sep 27;10:e71969. doi: 10.7554/eLife.71969. Online ahead of print.

ABSTRACT

Neurophysiological studies depend on a reliable quantification of whether and when a neuron responds to stimulation. Simple methods to determine responsiveness require arbitrary parameter choices, such as binning size, while more advanced model-based methods require fitting and hyperparameter tuning. These parameter choices can change the results, which invites bad statistical practice and reduces the replicability. New recording techniques that yield increasingly large numbers of cells would benefit from a test for cell-inclusion that requires no manual curation. Here, we present the parameter-free ZETA-test, which outperforms t-tests, ANOVAs, and renewal-process-based methods by including more cells at a similar false-positive rate. We show that our procedure works across brain regions and recording techniques, including calcium imaging and Neuropixels data. Furthermore, in illustration of the method, we show in mouse visual cortex that 1) visuomotor-mismatch and spatial location are encoded by different neuronal subpopulations; and 2) optogenetic stimulation of VIP cells leads to early inhibition and subsequent disinhibition.

PMID:34570697 | DOI:10.7554/eLife.71969

Arch Argent Pediatr. 2021 Oct;119(5):e435-e440. doi: 10.5546/aap.2021.eng.e435.

ABSTRACT

INTRODUCTION: Hospital readmissions in pediatrics are a severe, potentially avoidable problem of health systems. In our setting, there is little information about this topic.

OBJECTIVE: To estimate the rate of readmissions, the proportion of potentially preventable readmissions, and their associated characteristics.

MATERIAL AND METHODS: Cross-sectional study including hospital readmissions of patients aged 0-18 years, admitted to a tertiary care children’s hospital between January 1st and December 31st, 2018. Readmissions were assessed as potentially preventable based on whether they were or not related to the previous admission.

RESULTS: Out of 8228 hospital admissions recorded in the study period, the rate of readmissions for any cause was 10 % at 30 days and 7.1 % at 15 days. The proportion of readmissions classified as potentially preventable was 47.9 % at 30 days and 47.5 % at 15 days. No statistically significant differences were observed between readmissions at 30 and 15 days in terms of patient age, health insurance, presence of chronic disease or cause of readmission.

CONCLUSION: The rate of hospital readmissions was 10 % at 30 days and 7.1 % at 15 days of discharge; almost half of them were considered potentially preventable.

PMID:34569745 | DOI:10.5546/aap.2021.eng.e435

Arch Argent Pediatr. 2021 Oct;119(5):325-330. doi: 10.5546/aap.2021.eng.325.

ABSTRACT

INTRODUCTION: Infections due to bacteremia in burn patients are a common cause of complications and an extended length of stay. Knowing causative microorganisms and identifying associated risk factors allow to reduce infectious complications, morbidity, mortality, and health care expenditure. This study assesses the extent of the association between risk factors and bacteremia in burn patients and identifies the most common microorganisms found in blood cultures.

POPULATION AND METHODS: Case-control study conducted at the Burn Intensive Care Unit of Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan” between June 1st, 2014 and September 30th, 2019 in patients with bacteremia events and a positive blood culture (cases) and patients with a negative blood culture (controls).

RESULTS: During the study period, 29 cases of bacteremia were identified. The median length of stay at the time of bacteremia was 23 days. The most commonly identified microorganism was Pseudomonas (7 cases). The only risk factor that showed a significant association was the presence of a central venous line for 7 days or more (OR: 3.18; 95 % confidence interval: 1.20- 8.38). The overall mortality rate was 9.1%; 13.8% for cases and 3.4% for controls.

CONCLUSIONS: Central venous lines for more than 7 days are an independent risk factor for bacteremia in critically ill burn children. No statistically significant association was established with other studied risk factors. Pseudomonas, Acinetobacter, and coagulase-negative Staphylococcus were the most common microorganisms found in bacteremia.

PMID:34569740 | DOI:10.5546/aap.2021.eng.325

J Int AIDS Soc. 2021 Sep;24(9):e25815. doi: 10.1002/jia2.25815.

ABSTRACT

INTRODUCTION: In sub-Saharan Africa, less than half of young people know their HIV status. HIV self-testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. We aimed to understand the uptake and acceptability of different HIV testing options for youth in Harare, Zimbabwe.

METHODS: This study was nested within a cluster randomized trial of a youth-friendly community-based integrated HIV and sexual and reproductive health intervention for youth aged 16-24 years. Three HIV testing options were offered: (1) provider-delivered testing; (2) HIVST on site in a private booth without a provider present; and (3) provision of a test kit to test off site. Descriptive statistics and proportions were used to investigate the uptake of HIV testing in a client sample. A focus group discussion (FGD) with intervention providers alongside in-depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Thematic analysis was used to analyse the qualitative data.

RESULTS: Between April and June 2019, 951 eligible clients were tested for HIV: 898 (94.4%) chose option 1, 30 (3.25%) chose option 2 and 23 (2.4%) chose option 3. Option 1 clients cited their trust in the service and a desire for immediate counselling, support and guidance from trusted providers as the reasons for their choice. Young people were not confident in their expertise to conduct HIVST. Concerns about limited privacy, confidentiality and lack of support in the event of an HIV-positive result were barriers for off-site HIVST.

CONCLUSIONS: In the context of supportive, trusted and youth-friendly providers, youth clients overwhelmingly preferred provider-delivered HIV testing over client-initiated HIVST or HIVST off site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own. They desire quality in-person counselling, guidance and support, alongside privacy and confidentiality. To increase the appeal of HIVST for youth, greater provision of access to private spaces is required, and accessible pre- and post-test counselling and support may improve uptake.

PMID:34569710 | DOI:10.1002/jia2.25815

Catheter Cardiovasc Interv. 2021 Sep 27. doi: 10.1002/ccd.29961. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop a model to predict risk of in-hospital bleeding following endovascular peripheral vascular intervention.

BACKGROUND: Peri-procedural bleeding is a common, potentially preventable complication of catheter-based peripheral vascular procedures and is associated with increased mortality. We used the National Cardiovascular Data Registry (NCDR) Peripheral Vascular Interventions (PVI) Registry to develop a novel risk-prediction model to identify patients who may derive the greatest benefit from application of strategies to prevent bleeding.

METHODS: We examined all patients undergoing lower extremity PVI at 76 NCDR PVI hospitals from 2014 to 2017. Patients with acute limb ischemia (n = 1600) were excluded. Major bleeding was defined as overt bleeding with a hemoglobin (Hb) drop of ≥ 3 g/dl, any Hb decline of ≥ 4 g/dl, or a blood transfusion in patients with pre-procedure Hb ≥ 8 g/dl. Hierarchical multivariable logistic regression was used to develop a risk model to predict major bleeding. Model validation was performed using 1000 bootstrapped replicates of the population after sampling with replacement.

RESULTS: Among 25,382 eligible patients, 1017 (4.0%) developed major bleeding. Predictors of bleeding included age, female sex, critical limb ischemia, non-femoral access, prior heart failure, and pre-procedure hemoglobin. The model demonstrated good discrimination (optimism corrected c-statistic = 0.67), calibration (corrected slope = 0.98, intercept of -0.04) and range of predicted risk (1%-18%).

CONCLUSIONS: Post-procedural PVI bleeding risk can be predicted based upon pre- and peri-procedural patient characteristics. Further studies are needed to determine whether this model can be utilized to improve procedural safety through developing and targeting bleeding avoidance strategies.

PMID:34569709 | DOI:10.1002/ccd.29961

Orthod Craniofac Res. 2021 Sep 27. doi: 10.1111/ocr.12537. Online ahead of print.

ABSTRACT

OBJECTIVE: Aim of this study was to compare the mechanical properties of orthodontic aligners among different commercially available 3D printing devices.

MATERIALS AND METHODS: Five 3D printers (Ka:rv LP 550, Swinwon; “KAR”), (L120, Dazz 3D; “L12”), (MiiCraft 125, Miicraft Jena; “MIC”), (Slash 2, Uniz; “SLS”) and (Pro 95, SprintRay; “PRO”) were used to prepare orthodontic aligners with dental resin (Tera Harz TC-85DAW, Graphy). The central incisors of each aligner were cut, prepared, and evaluated in terms of Martens-Hardness (HM), indentation-modulus (E_IT ), and elastic-index (η_IT ) as per ISO14577-1:2002. Force-indentation curves were recorded and differences among printers were checked with generalized linear regressions (alpha=5%).

RESULTS: Statistically significant differences were seen for all mechanical properties (P<0.05), which were in descending order: HM (N/mm² ) as median (Interquartile Range [IQR]): SLS 108.5 (106.0-112.0), L12 103.0 (102.0-107.0), KAR 101.5 (97.5-103.0), MIC 100.0 (97.5-101.5), and PRO 94.0 (93.0-96.0); E_IT (MPa) as mean (Standard Deviation [SD]): SLS 2696.3 (124.7), L12 2627.8 (73.5), MIC 2566.2 (125.1), KAR 2565.0 (130.2), PRO 2491.2 (53.3); η_IT (%) as median (IQR): SLS 32.8 (32.3-33.1), L12 31.6 (30.8-32.3), KAR 31.3 (30.9-31.9), MIC 30.5 (29.9-31.2), PRO 29.5 (29.1-30.0). Additionally, significant differences existed between Liquid Crystal Display (LCD) and Digital Light Processing (DLP) printers for HM (P<0.001), E_IT (P=0.002), and η_IT (P<0.001), with aligners from the former having higher values than aligners from the latter printer.

CONCLUSION: Under the limitations of this study it may be concluded that the mechanical properties of 3D-printed orthodontic aligners are dependent on the 3D printer used and thus differences in their clinical efficacy are anticipated.

PMID:34569692 | DOI:10.1111/ocr.12537