Tag: pubmed

Vector Borne Zoonotic Dis. 2021 Aug 31. doi: 10.1089/vbz.2021.0027. Online ahead of print.

ABSTRACT

Three tick species that can transmit pathogen causing disease are commonly found parasitizing people and animals in the mid-Atlantic United States: the blacklegged tick (Ixodes scapularis Say), the American dog tick (Dermacentor variabilis [Say]), and the lone star tick (Amblyomma americanum [L.]) (Acari: Ixodidae). The potential risk of pathogen transmission from tick bites acquired at schools in tick-endemic areas is a concern, as school-aged children are a high-risk group for tick-borne disease. Integrated pest management (IPM) is often required in school districts, and continued tick range expansion and population growth will likely necessitate IPM strategies to manage ticks on school grounds. However, an often-overlooked step of tick management is monitoring and assessment of local tick species assemblages to inform the selection of control methodologies. The purpose of this study was to evaluate tick species presence, abundance, and distribution and the prevalence of tick-borne pathogens in both questing ticks and those removed from rodent hosts on six school properties in Maryland. Overall, there was extensive heterogeneity in tick species dominance, abundance, and evenness across the field sites. A. americanum and I. scapularis were found on all sites in all years. Overall, A. americanum was the dominant tick species. D. variabilis was collected in limited numbers. Several pathogens were found in both questing ticks and those removed from rodent hosts, although prevalence of infection was not consistent between years. Borrelia burgdorferi, Ehrlichia chaffeensis, Ehrlichia ewingii, and Ehrlichia “Panola Mountain” were identified in questing ticks, and B. burgdorferi and Borrelia miyamotoi were detected in trapped Peromyscus spp. mice. B. burgdorferi was the dominant pathogen detected. The impact of tick diversity on IPM of ticks is discussed.

PMID:34463140 | DOI:10.1089/vbz.2021.0027

Blood Adv. 2021 Aug 30:bloodadvances.2021004341. doi: 10.1182/bloodadvances.2021004341. Online ahead of print.

ABSTRACT

BACKGROUND: Allogeneic blood or marrow transplant (BMT) recipients are at risk for venous-thromboembolism (VTE) because of high-intensity therapeutic exposures, comorbidities and a pro-inflammatory state due to chronic graft vs. host disease (GvHD). The long-term risk of VTE in allogeneic BMT survivors remains unstudied.

METHODS: Participants were drawn from the BMT Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived ≥2y after BMT. The BMTSS survey collected information on sociodemographics, health behaviors and chronic health conditions along with age at diagnosis. Details regarding primary cancer diagnosis, transplant preparative regimens, type of transplant and stem cell source were obtained from institutional databases and medical records. We analyzed the risk of VTE in 1,554 2y survivors of allogeneic BMT compared to 907 siblings. Using backward variable selection guided by minimizing Akaike’s information criterion, we created a prediction model for risk of late-occurring VTE.

RESULTS: Allogeneic BMT survivors had a 7.3-fold higher risk of VTE compared to siblings (95%CI: 4.69-11.46, p<0.0001). After a median follow-up of 11y (inter-quartile range: 6-18y), and conditional on surviving the first 2y after BMT, the cumulative incidence of late-occurring VTE was 2.4% at 5y, 4.9% at 10y and 7.1% at 20y after BMT. Older age at BMT (hazard ratio [HR]=1.02/y, 95%CI=1.01-1.04, p=0.002), use of immunosuppressive medications (HR=2.28, 95%CI=1.41-3.38, p=0.0008), obesity (HR=1.06/unit increase in body mass index, 95%CI=1.02-1.10, p=0.002), history of stroke (HR=3.71, 95%CI=1.66-8.27, p=0.001), chronic GvHD (HR=1.62, 95%CI=1.00-2.60, p=0.049), and use of peripheral blood stem cells (PBSCs) as source of stem cells compared to bone marrow (HR=2.73, 95%CI=1.65-4.50, p<0.0001) were associated with increased VTE risk. The final model for VTE risk applied at 2y post-BMT (“HiGHS2”) included History of stroke, chronic GvHD, Hypertension, Sex (male vs. female) and Stem cell source (PBSCs vs. other) (corrected C-statistics: 0.73; 95%CI=0.67-0.79), and was able to classify patients at high and low VTE risk (10y cumulative incidence 9.3% vs. 2.4%, p<0.0001).

CONCLUSIONS: The BMTSS HiGHS2 risk model when applied at 2y post-BMT can be used to inform targeted prevention strategies for patients at high risk for late-occurring VTE.

PMID:34461633 | DOI:10.1182/bloodadvances.2021004341

Rev Bras Ginecol Obstet. 2021 Jul;43(7):507-512. doi: 10.1055/s-0041-1735129. Epub 2021 Aug 30.

ABSTRACT

OBJECTIVE: To evaluate the factors associated with abortion complications following the implementation of the good-practice surveillance network Mujeres en Situación de Aborto (Women Undergoing Abortion, MUSA, in Spanish).

METHODS: A cross-sectional study with women who underwent abortion due to any cause and in any age group at UNICAMP Women’s Hospital (part of MUSA network), Campinas, Brazil, between July 2017 and Agust 2019. The dependent variable was the presence of any abortion-related complications during hospitalization. The independent variables were clinical and sociodemographic data. The Chi-square test, the Mann-Whitney test, and multiple logistic regression were used for the statistical analysis.

RESULTS: Overall, 305 women were enrolled (mean ± standard deviation [SD] for age: 29.79 ± 7.54 years). The mean gestational age was 11.17 (±3.63) weeks. Accidental pregnancy occurred in 196 (64.5%) cases, 91 (29.8%) due to contraception failure. At least 1 complication was observed in 23 (7.54%) women, and 8 (34.8%) of them had more than 1. The most frequent complications were excessive bleeding and infection. The factors independently associated with a higher prevalence of complications were higher gestational ages (odds ratio [OR]: 1.22; 95% confidence interval [95%CI]: 1.09 to 1.37) and contraceptive failure (OR: 3.4; 95%CI: 1.32 to 8.71).

CONCLUSION: Higher gestational age and contraceptive failure were associated with a higher prevalence of complications. This information obtained through the surveillance network can be used to improve care, particularly in women more susceptible to unfavorable outcomes.

PMID:34461660 | DOI:10.1055/s-0041-1735129

Digestion. 2021 Aug 30:1-8. doi: 10.1159/000516482. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: In chronic pancreatitis (CP), progressive fibrosis of the pancreas leads to exocrine and endocrine insufficiency and, finally, to pancreatic burnout. Alcohol consumption is associated with fibrosis in the pancreas and the liver, and the activation of stellate cells plays a central role in the induction of fibrosis in both organs. However, the relationship between pancreatic burnout and liver cirrhosis (LC) is still poorly understood in patients with alcoholic CP (ACP).

METHODS: We performed a single-center, retrospective, cross-sectional study with 537 CP patients. We analyzed the clinical presence of early and advanced pancreatic burnout and stated LC in cases of typical alterations in histology, liver stiffness measurement, cross-sectional imaging, or ultrasound. We analyzed further clinical parameters.

RESULTS: The frequency of advanced pancreatic burnout was 6.5% for ACP (20/306) and 4% for non-ACP (8/206; p = 0.20; χ2 test). Advanced pancreatic burnout was not associated with the amount of alcohol consumption (p = 0.34) but with the disease duration (p = 0.0470) and rate of calcification (p = 0.0056). Furthermore, advanced pancreatic burnout was associated with LC (p < 0.0001) but cannot be explained by the amount of alcohol consumption. In ACP with alcohol consumption >80 g/day, an isolated LC was significantly more frequently detectable (14%, without pancreatic burnout) than an isolated advanced pancreatic burnout (1%, without LC). These results were confirmed by multivariable analyses.

CONCLUSIONS: We identified a close association between LC and pancreatic burnout. The disease duration positively correlates with the development of pancreatic burnout. The liver seems to be more vulnerable to alcohol than the pancreas.

PMID:34461618 | DOI:10.1159/000516482

J Cardiopulm Rehabil Prev. 2021 Sep 1;41(5):308-314. doi: 10.1097/HCR.0000000000000643.

ABSTRACT

PURPOSE: Provision of phase 2 cardiac rehabilitation (CR) has been directly impacted by coronavirus disease-19 (COVID-19). Economic analyses to date have not identified the financial implications of pandemic-related changes to CR. The aim of this study was to compare the costs and reimbursements of CR between two periods: (1) pre-COVID-19 and (2) during the COVID-19 pandemic.

METHODS: Health care costs of providing CR were calculated using a microcosting approach. Unit costs of CR were based on staff time, consumables, and overhead costs. Reimbursement rates were derived from commercial and public health insurance. The mean cost and reimbursement/participant were calculated. Staff and participant COVID-19 infections were also examined.

RESULTS: The mean number of CR participants enrolled/mo declined during the pandemic (-10%; 33.8 ± 2.0 vs 30.5 ± 3.2, P = .39), the mean cost/participant increased marginally (+13%; $2897 ± $131 vs $3265 ± $149, P = .09), and the mean reimbursement/participant decreased slightly (-4%; $2959 ± $224 vs $2844 ± $181, P = .70). However, these differences did not reach statistical significance. The pre-COVID mean operating surplus/participant ($62 ± $140) eroded into a deficit of -$421 ± $170/participant during the pandemic. No known COVID-19 infections occurred among the 183 participants and 14 on-site staff members during the pandemic period.

CONCLUSIONS: COVID-19-related safety protocols required CR programs to modify service delivery. Results demonstrate that it was possible to safely maintain this critically important service; however, CR program costs exceeded revenues. The challenge going forward is to optimize CR service delivery to increase participation and achieve financial solvency.

PMID:34461621 | DOI:10.1097/HCR.0000000000000643

J Forensic Leg Med. 2021 Aug 27;83:102249. doi: 10.1016/j.jflm.2021.102249. Online ahead of print.

ABSTRACT

BACKGROUND: Law enforcement activity can involve firearms, and either a civilian or the law enforcement officer can be injured. It was the purpose of this study to characterize the injuries and demographics associated with law enforcement firearm activity across the entire US using a national data base.

METHODS: Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study data 1993-2015 was used. Law enforcement involvement and other demographic variables were ascertained. Statistical analyses were performed accounting for the weighted, stratified nature of the data. P < 0.05 was considered to be statistically significant.

RESULTS: There were an estimated 2,667,896 ED visits for injuries due to firearms; 1.7% (45,497) were associated with law enforcement. Those involved with law enforcement were older (33.2 vs 29.8 years), a handgun was more commonly involved (80.3 vs 71.5%), male (90.7 vs 86.8%), White (52.9 vs 37.2%), had more upper trunk injuries (25.2 vs 16.2%), fewer lower extremity (15.1% vs 25.9%) injuries, and more fatalities (10.0 vs. 6.2%). An argument, crime, fight and drug involvement were all greater in the law enforcement group. Within the law enforcement group, when the injured patient was the civilian and not the officer, the patient was more commonly Black, male, sustained more trunk injuries, fewer extremity injuries, and more frequently admitted to the hospital. The civilian group had fewer upper extremity (11.7% vs 29.7%), lower extremity (12.2% vs 23.7%) and lower trunk injuries (14.6% vs 8.0%), more upper trunk injuries (31.3% vs 7.8%, and similar proportion of head/neck injuries (31.5% vs 30.7%) compared to the officer group. More females were injured in the officer group (16.9% vs 7.5%). The fatality rate was 12.6% for the civilian group and 3.0% for the officer group. There were no differences by race in disposition from the ED (released, admitted, death) for those who sustained injuries by the officer.

CONCLUSIONS: Firearm injuries due to law enforcement activity occurred in 1.7% of all ED visits for injuries due to firearms. The law enforcement officer was the injured patient in 23% of the events. This study spanning nearly a quarter of a century of data for injuries due to firearm activity resulting in ED visits is baseline data for future studies, especially in the present setting of calls for police reform within the US. This will be important when analyzing the effect of new programs in law enforcement training and/or police reform.

PMID:34461598 | DOI:10.1016/j.jflm.2021.102249

J Surg Res. 2021 Aug 27;268:521-526. doi: 10.1016/j.jss.2021.07.039. Online ahead of print.

ABSTRACT

BACKGROUND: Patients frequently use online physician ratings websites (PRWs) to identify physicians for care. PRWs provide physician information and reviews. However, the accuracy of PRWs is uncertain. We investigated the accuracy and validity of Healthgrades with respect to endocrine surgery. We identified factors associated with reported board certification inaccuracy, higher ratings, greater quantity of ratings.

MATERIALS AND METHODS: The search term “endocrine surgery specialist” was used and the search was limited to a 25-mile radius around Philadelphia, PA. Data was collected on physician sex, age, board certification, surgical specialty, quantity of ratings, average rating, response to comments, and provision of a self-description. Descriptive statistics were performed to examine surgeon characteristics, ratings, and reported board certifications. Board certification accuracy was determined by searching the corresponding American Board website and calculating a kappa statistic. Logistic regression was performed to identify factors associated with board certification inaccuracy, higher average ratings, and higher quantity of ratings.

RESULTS: A total of 300 physicians were identified. Eighty-four percent of listed board certifications were accurate; the kappa statistic for accuracy of board certification was 0.634. Providing a response to comments and greater quantity of ratings were associated with higher average ratings. Provision of a self-description, male sex, and younger age were identified as factors associated with higher quantity of ratings.

CONCLUSIONS: A wide range of specialties are identified as endocrine surgery specialists. The reliability of board certification reporting was moderate. Increased surgeon involvement with the Healthgrades site was inconsistently associated with higher average ratings and higher quantity of ratings but lower accuracy.

PMID:34461603 | DOI:10.1016/j.jss.2021.07.039

Clin Nutr. 2021 Jul 27;40(9):5114-5121. doi: 10.1016/j.clnu.2021.07.023. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes.

METHODS: On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay.

RESULTS: The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered.

CONCLUSIONS: Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.

PMID:34461585 | DOI:10.1016/j.clnu.2021.07.023

Clin Nutr. 2021 Aug 8;40(9):5162-5168. doi: 10.1016/j.clnu.2021.07.032. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity.

METHODS: A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested.

RESULTS: In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI.

CONCLUSION: BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.

PMID:34461590 | DOI:10.1016/j.clnu.2021.07.032

J Reprod Immunol. 2021 Aug 24;147:103368. doi: 10.1016/j.jri.2021.103368. Online ahead of print.

ABSTRACT

Recent studies suggest that women with high exposures to dibutyl phthalate (DBP) are at increased risk for preterm birth, a condition associated with aberrant inflammation in the placenta often caused by subclinical infections. Placental inflammation is also a risk factor for neurodevelopmental disorders whose risk may also be enhanced by DBP. It is unclear, however, if DBP enhances placental inflammation. Therefore, we studied the effects of DBP on the production of biomarkers of placental inflammation and neurodevelopment under basal conditions and a setting of mild infection. Placental explant cultures established from women undergoing elective caesarean delivery were treated with DBP with and without co-stimulation by 10⁷ CFU/mL heat-killed E. coli for 24 h at 37 °C. Conditioned medium was harvested and concentrations of IL-1β, TNF-α, IL-10, HO-1 and BDNF, a biomarker for neurodevelopment, were quantified. DBP significantly enhanced IL-6 production in basal cultures but had no significant on the other biomarkers quantified. Both TNF-α and IL-1β production was enhanced by DBP for cultures co-stimulated with E. coli. Although marginal enhancement of IL-6, and IL-10 were observed for bacteria co-treated cultures, results were either non-monotonic or only approached statistical significance. HO-1 production tended to be reduced at the highest concentration of DBP tested and BDNF production was reduced by DBP in a dose-dependent manner for bacteria-stimulated cultures. These results suggest that DBP enhances basal IL-6 production but has little or no effect on other biomarkers studied. However, DBP enhances IL-1β and TNF-α production but reduces BDNF production by bacteria-stimulated cultures.

PMID:34461555 | DOI:10.1016/j.jri.2021.103368