Search

Case in the paper is of a 24-year-old woman presenting to Baqiyatallah hospital, Tehran, Iran with the occasional fever, weakness, myalgia, fatigue, body aches, and headache who was diagnosed with Coronavirus disease-19 (COVID-19) PCR test. Chest computed tomography (CT) showed spontaneous pneumomediastinum (SPM) and pneumopericardium (SPP). Here, we described SPM, and SPP in a patient with COVID-19, presenting a severe course of the disease.

We report the case of a 37-year-old man who was admitted to Baqiyatallah hospital in Tehran (Iran) for retrosternal pain, fever, fatigue, dyspnoea and severe non-productive cough. The patient was subsequently confirmed as positive for COVID-19 at real-time polymerase chain reaction (RT-PCR) test. Chest computed tomography (CT) revealed also the presence of pneumomediastinum. This case highlights the importance of chest CT imaging for COVID-19 pneumonia to detect co-existing conditions as pneumomediastinum.

Diabetic retinopathy (DR) is a medical condition caused by damage to the blood vessels of retina tissue due to diabetes mellitus. DR leads to injury in neural and vascular structures and is reported to be significantly influenced by inflammation and inflammatory mediators like cytokines. In this study, a systematic review and meta-analysis were performed to analyze the association between cytokine gene polymorphisms and DR. We identified relevant studies from Scopus, PubMed, and Google scholar databases. Allele and genotype frequencies were pooled. Heterogeneity and publication bias were explored. The odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated to estimate the relation. A total of 3337 cases and 4945 controls in 19 eligible studies were included in the meta-analysis. Overall, results indicated the negative association between the cytokine gene polymorphisms and DR susceptibility in the allelic model (IFN-γ (rs2430561): OR 0.64, [CI]: 0.5 to 0.82; and TGF-β (rs1800471): [OR] = 0.15, [CI]: 0.03 to 0.79); and also, in the dominant model (IFN-γ (rs2430561): OR = 0.4, [CI]: 0.22 to 0.75; and TGF-β (rs1800471): OR = 0.14, [CI]: 0.05 to 0.4). The present study suggests that IFN-γ (rs2430561) and TGF-β (rs1800471) polymorphisms are associated with decreased susceptibility to DR.

Graphic abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01145-4.

Background Respiratory rate (RR) is one of the most important physiologic measures for predicting patients’ deterioration of clinical condition and final prognosis. In several studies, RR has been the most important predictor of patients’ prognoses. Objectives The objective of this study was to conduct a cost-utility analysis to estimate the cost and effectiveness of automatic respiratory rate monitoring (ARRM) with a non-invasive sensor (RespiraSense™) plus intermittent nurse-led RR monitoring (ARRM strategy) compared with intermittent nurse-led RR monitoring (IM strategy) in patients admitted to hospital in the UK with pneumonia. Methods A decision analytic model was developed based on a hypothetical cohort of patients who were admitted to hospital with pneumonia. After admission, the patients could be monitored with either ARRM or IM strategies. The outcomes of interest included total costs and total effectiveness of each strategy, including length of stay (LoS) in hospital, LoS in intensive care unit, quality-adjusted life-years (QALYs), deaths, and incremental cost per QALY gained. An incremental cost of £20,000 or less per QALY gained was considered cost effective. A lifetime time horizon (38 years) was used to capture the long-term benefits. Probabilistic and deterministic sensitivity analyses were performed. Results Total costs of patient care in ARRM and IM strategies were £1986.9 million and £2079.4 million, respectively. Total incremental QALYs lived were 3548 higher in the intervention arm (ARRM), meaning that the ARRM strategy was dominant (i.e., less costly [£92.6 million less] and more effective). The results were stable in probabilistic and most of the deterministic sensitivity analyses. Results from threshold analysis indicated that a minimum of 7 and 10% improvement in percentage of early detection of respiratory compromise is required for ARRM to become cost effective and cost saving, respectively. Conclusions Our results indicate that ARRM using RespiraSense, in addition to intermittent nurse-led monitoring of RR, in patients admitted to the hospital with pneumonia could be a cost-saving and cost-effective intervention if the minimum clinical thresholds are met.

The purpose of the present analysis was to explore the cost-effectiveness of tisagenlecleucel in relapsed or refractory (r/r) paediatric acute lymphoblastic leukaemia (pALL) and r/r adult diffuse large B-cell lymphoma (DLBCL) in Switzerland against a range of historical standard-of-care treatments. Two cost-utility models were constructed for the two licensed indications using similar methodologies but indication-specific data. Clinical efficacy data were based on pooled analyses of clinical trials for tisagenlecleucel (pALL: ELIANA, ENSIGN, B2101J; DLBCL: JULIET, NCT02030834) and published data for comparator treatments. Treatment effects were compared based on matching-adjusted indirect comparison (MAIC) analyses. Four clinical lymphoma and leukaemia experts provided Switzerland-specific input regarding comparators, diagnostic and therapeutic procedures, clinical evidence and costs, which were used to inform the models. The base case analysis reflected the perspective of the Swiss mandatory health insurance system. Deterministic, probabilistic and scenario analyses were carried out to explore the robustness of results. The base case analysis resulted in incremental costs of CHF 31,961–CHF 36,419 per quality-adjusted life year (QALY) gained for pALL across the different comparators and CHF 113,179 for DLBCL (1 CHF = 1.09 USD). Incremental costs per life-year gained ranged between CHF 33,906–CHF 97,399 across the two indications. Including productivity gains, tisagenlecleucel was shown to be dominant (more effective and less costly) over all the comparators for pALL and to result in incremental costs per life-year gained of CHF 57,324 for DLBCL. Using hypothetical willingness-to-pay thresholds of CHF 100,000–150,000 per QALY gained, the present analysis has shown tisagenlecleucel to be a cost-effective treatment option in pALL and DLBCL.

Background Granulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, is an idiopathic systemic disease typically affecting the lungs, although other organs may also be involved. Case presentation A 28-year-old male was admitted to Baqiyatallah university hospital in Teheran (Iran) after a 3-week history of fever and productive cough. The patient gradually developed fatigue, arthralgia, hematuria, nausea, vomiting, dyspnea, hemoptysis, weight loss, oliguria and then anuria. Chest-X-ray (CXR) and computerized tomography scan revealed cavitating nodular opacities in the right lung lobe. Furthermore, plasma creatinine increased from 2.2 to 4 mg/dl in a few days. Histopathological examination of kidney biopsy revealed peri-glomerular and peri-vascular inflammation, degeneration and necrosis of the tubular epithelial lining, red blood cell casts, distorted glomerular structure, fibrin thrombi, segmental breaks of the glomerular basal membrane, disruption of Bowman's capsular membrane and crescent formation of the affected glomeruli. An abnormal CXR, an abnormal urinary sediment and a typical kidney histology were used as criteria to diagnose glomerulonefritis with poliangiitis (GPA). Bronchoalveolar lavage smear and PCR turned out positive for mycobacterium tuberculosis. After 3 months of treatment for (GPA) and tuberculosis the patient developed headache and seizure. Cerebral Magnetic Resonance Venography revealed cerebral venous thrombosis of the sinus transverse and sigmoid. Conclusions Tuberculosis may coexist with GPA, as it occurred in our patient. Since a crescentic glomerulonephritis can progress to renal failure, clinicians should always be aware of potential multiple conditions when considering differential diagnoses.

Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to have elevated prevalence of psychiatric symptoms, but little is known about HCWs with psychiatric diagnoses. To examine their response to the pandemic, we analyzed their perspective, and association with psychiatric symptoms and stress among HCW with psychiatric diagnosis. Using an online survey of HCW, we analyzed demographics, work information, health factors, open-ended question, sources of stress and standardized mental health scales (Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Posttraumatic Stress Disorder Checklist (PCL)). Sixteen out of 129 HCWs reported a pre-existing psychiatric diagnosis (median age 32 years, 8 were females, 8 work in the emergency department). Their perception of the impact severity on symptoms was significantly correlated with all the mental health scales and with stress from avoiding physical contact. In multivariate analysis, PSS score and PCL score were associated with self-rated impact of the COVID-19 pandemic on symptoms (standardized beta = .51 for PCL and standardized beta = .55 for PSS). GAD-7 score was significantly related to both impact (standardized beta = .44) and stress from avoiding physical contact (standardized beta = .53). HCWs with psychiatric diagnoses reported a range of perception of the impact of the pandemic on their symptoms with increased severity associated with worse psychiatric outcomes and more stress from avoiding physical contact with others. There is a growing importance to protect HCWs mental health, including those with pre-existing psychiatric diagnosis, and proactively counter psychosocial consequences of healthcare crises.

Although vitamin D deficiency has been associated with diabetes complications, the underlying mechanisms have not been clarified in human studies yet. This clinical trial was designed to evaluate the effect of vitamin D supplementation on serum levels and gene expression of some polyols and hexamine pathway enzymes, which play pivotal roles in the incidence of diabetes complications. Seventy-four patients with type 2 diabetes were randomly divided into two groups as receiving vitamin D (100 μg/d equal to 4000 IU/d) or placebo for a 3-month period. Moreover, serum levels of insulin, fasting plasma glucose (FPG), vitamin D, HbA1c, aldose reductase (AR), O-linked N-acetyl glucosamine transferase (OGT), and glutamine fructose ‐6‐phosphate aminotransferase (GFPT), as well as the gene expression of mentioned enzymes in PBMCs were measured before and after the intervention. After 3-months intervention, 25 (OH) vitamin D level significantly increased in the vitamin D group. The expression of AR and GFPT genes significantly decreased and some significant differences were observed regarding the serum level of AR enzyme. Additionally, insulin showed significant increase following vitamin D intake. Our result show that, receiving 100 μg/d vitamin D in type 2 diabetes patients, for a 3-month period might be helpful for ameliorating diabetes complications not only by improving insulin level, but also by suppressing AR and GFPT gene expressions in PBMC.

Rising numbers of patients on the liver transplant waiting list has led to the utilization of organs from higher-risk donors that are more likely to be discarded and are prone to post-transplant co...

Objective: The prevalence of migraine is higher in patients with gastrointestinal disorders. Possible underlying mechanisms could be increased intestinal permeability and systemic inflammation. Pro...

Simulation of the behavior of stenosis arteries has received much attention as a research topic. Fluid mechanics of blood flow in the left coronary artery (LCA) with stenosis is studied using a mathematical analysis. Numerical simulations of blood flow in the left coronary artery with different stenosis percentages were performed. Both Newtonian and non-Newtonian models were considered for blood. The flow was assumed to be pulsatile and laminar. Stenotic human coronary artery geometries were given based on the images obtained from real patients (coronarography). The coupled governing equations, continuity and momentum were non-dimensionalized and solved. The effect of stenosis on various physiologically important flow variables during the cardiac cycle including pressure drop, impedance, velocity profile, and wall shear stress (WSS) was studied. It is found that all these flow parameters remarkably vary across a stenotic lesion. Also, an increase in the stenosis percentage leads to a considerable increase in their magnitudes.

Background Surgical interventions for the treatment of stress urinary incontinence (SUI) in women are commonly employed following the failure of minimally invasive therapies. Due to the limited information available on the relative cost-effectiveness of available surgeries for treating SUI, a de novo economic analysis was conducted to assess costs and effects of all relevant surgeries. To inform the economic analysis, the objective of this review was to identify and assess the quality of existing economic evaluation studies on different surgical interventions for the treatment of SUI in women. Methods The following databases were searched during the review process: Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process, Excerpta Medica Database (Embase), National Health Service Economic Evaluation Database (NHS EED), and Health Management Information Consortium and Cost-Effectiveness Analysis Registry (CEA registry). The key criteria for inclusion were that the study population included women with SUI and that the surgical interventions considered were utilised as either a primary or a follow-up surgery. The review included only full economic evaluations. Studies were quality assessed using the Drummond checklist for economic evaluations. No quantitative synthesis of the results by meta-analysis was conducted due to the high methodological heterogeneity. Results Twenty-six economic evaluations were included, of which 13 were model-based analyses. Surgical treatments assessed most frequently were mid-urethral slings and open and laparoscopic colposuspension. There were some differences in the methodological approaches taken, including differences in type of economic analysis, perspective, time horizon, types of resource use, and costs and outcomes that were included in the analysis. The majority of studies conducted a cost-utility analysis from a health system perspective and applied a time horizon of between 1 and 5 years. The cost-effectiveness results suggest that single-incision mini-sling and mid-urethral slings are among the most cost-effective options. Conclusions The review has shown that methods used for the economic evaluation of surgical treatments for SUI vary widely in terms of study design, analysis type, compared alternatives, time horizon, costing methodologies and effect outcomes. Future economic evaluation studies on surgical treatments for SUI may be improved by the application of available guidelines. Systematic review registration Registered in PROSPERO in 2016, CRD42016049339

Background Malignant melanoma is the fifth most common cancer in the UK, with rates continuing to rise, resulting in considerable burden to patients and the NHS. Objectives The objectives were to evaluate the effectiveness and cost-effectiveness of current and alternative follow-up strategies for stage IA and IB melanoma. Review methods Three systematic reviews were conducted. (1) The effectiveness of surveillance strategies. Outcomes were detection of new primaries, recurrences, metastases and survival. Risk of bias was assessed using the Cochrane Collaboration’s Risk-of-Bias 2.0 tool. (2) Prediction models to stratify by risk of recurrence, metastases and survival. Model performance was assessed by study-reported measures of discrimination (e.g. D-statistic, Harrel’s c-statistic), calibration (e.g. the Hosmer–Lemeshow ‘goodness-of-fit’ test) or overall performance (e.g. Brier score, R 2). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). (3) Diagnostic test accuracy of fine-needle biopsy and ultrasonography. Outcomes were detection of new primaries, recurrences, metastases and overall survival. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies–2 (QUADAS–2) tool. Review data and data from elsewhere were used to model the cost-effectiveness of alternative surveillance strategies and the value of further research. Results (1) The surveillance review included one randomised controlled trial. There was no evidence of a difference in new primary or recurrence detected (risk ratio 0.75, 95% confidence interval 0.43 to 1.31). Risk of bias was considered to be of some concern. Certainty of the evidence was low. (2) Eleven risk prediction models were identified. Discrimination measures were reported for six models, with the area under the operating curve ranging from 0.59 to 0.88. Three models reported calibration measures, with coefficients of ≥ 0.88. Overall performance was reported by two models. In one, the Brier score was slightly better than the American Joint Committee on Cancer scheme score. The other reported an R 2 of 0.47 (95% confidence interval 0.45 to 0.49). All studies were judged to have a high risk of bias. (3) The diagnostic test accuracy review identified two studies. One study considered fine-needle biopsy and the other considered ultrasonography. The sensitivity and specificity for fine-needle biopsy were 0.94 (95% confidence interval 0.90 to 0.97) and 0.95 (95% confidence interval 0.90 to 0.97), respectively. For ultrasonography, sensitivity and specificity were 1.00 (95% confidence interval 0.03 to 1.00) and 0.99 (95% confidence interval 0.96 to 0.99), respectively. For the reference standards and flow and timing domains, the risk of bias was rated as being high for both studies. The cost-effectiveness results suggest that, over a lifetime, less intensive surveillance than recommended by the National Institute for Health and Care Excellence might be worthwhile. There was considerable uncertainty. Improving the diagnostic performance of cancer nurse specialists and introducing a risk prediction tool could be promising. Further research on transition probabilities between different stages of melanoma and on improving diagnostic accuracy would be of most value. Limitations Overall, few data of limited quality were available, and these related to earlier versions of the American Joint Committee on Cancer staging. Consequently, there was considerable uncertainty in the economic evaluation. Conclusions Despite adoption of rigorous methods, too few data are available to justify changes to the National Institute for Health and Care Excellence recommendations on surveillance. However, alternative strategies warrant further research, specifically on improving estimates of incidence, progression of recurrent disease; diagnostic accuracy and health-related quality of life; developing and evaluating risk stratification tools; and understanding patient preferences. Study registration This study is registered as PROSPERO CRD42018086784. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol 25, No. 64. See the NIHR Journals Library website for further project information.

Cavitary lung formation with spontaneous pneumothorax has been rarely reported as a complication of COVID-19 pneumonia. We report a rare case of a 38 years-old male patient affected by COVID-19 pneumonia, exceptionally complicated by a simultaneous giant cavity in the right upper lung and a small right pneumothorax in the right hemithorax. Whilst pneumothorax emphysema, giant bullae and pneumothorax with alveolar rupture are known to potentially develop in COVID-19 patients as a result of high-flow O2 support, the exact origin of the giant lung cavitation in our patient could be not confirmed. Cavitary lesions – featured by high mortality rate - are reportedly associated with lung infarctions and can be the aftermaths of pulmonary embolism, a rather common sequela of COVID-19 pneumonia. Radiological imaging is critical to support clinical decision making in the management of COVID-19 pneumonia, since not only it can visualize and stage the disease, but it can also detect and monitor the eventual onset of complications over time, even following patient discharge from hospital.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.

A 51-year-old man known to be affected by Mounier-Kuhn syndrome (MKS). presented to Accident & Emergecy (A&E) with fever, dyspnea and deterioration of his chronic coughs. Increased diameters of his trachea (39 mm), right (30 mm) and left (26 mm) main bronchi were revealed by chest computerized tomography (CT) scan. CT scan showed also ground-glass opacities (GGO) and bronchiectasis in the mid and lower zones of both lungs. COIVD-19 infection was eventually confirmed by RT-PCR. A severe form of COVID-19 could occur even in the early stages of the disease in presence of underlying co-morbidities including MKS, which increases the susceptibility to more recurrent and severe respiratory infections.

BACKGROUND Phobias, including arachnophobia, are common and can be treated with exposure therapy, a method that is limited by a lack of feared objects/situations in clinical settings. METHODS In a pilot parallel randomized controlled trial (RCT) to test the feasibility and efficacy of augmented reality exposure therapy (ARET), 25 men and women ages 18 to 45 with arachnophobia were designated (ABAB block allocation) to ARET for arachnophobia (n = 13) or waitlist control (n = 12). Data were collected at baseline, 1-week, and 1-month follow-up, and single-session ARET occurred immediately following baseline collection for the intervention group. RESULTS All ARET participants were able to touch a live tarantula or the tank containing it after single-session exposure; the control group remained >1 meter away from the tank. Effects persisted or improved at 1-month followup. The Fear of Spiders Questionnaire (FSQ) and Behavioral Approach Test (BAT) showed large, significant beneficial effects of ARET compared with a waitlist control group (BAT: P < .001, partial eta squared = .542; FSQ: P < .001, partial eta squared = .720). CONCLUSIONS We found ARET can feasibly be delivered using a wearable device running novel software with rapid responses and sustained effects. Replication and expansion of this pilot RCT will further support use of ARET for this and other specific phobias.

BackgroundAlthough there is recognized that Targeted Temperature Management (TTM) can improve neurological outcomes and survival in patients resuscitated from out of hospital cardiac arrest, the cost-effectiveness of multiple methods of TTM is still uncertain.ObjectiveThis study aimed to evaluate the cost-effectiveness of Intravascular Temperature Management (IVTM) through Thermogard XP in targeted temperature management compared to surface cooling method after cardiac arrest in England.MethodsWe developed a multi-state Markov model that compared intravascular temperature management through Thermogard XP and the surface cooling method through two different devices including Blanketrol III and Arctic Sun 5000, over a short-term and lifetime horizon. Model input parameters were obtained from the literature and local databases. We assumed hypothetical cohort of 1,000 patients who need TTM after cardiac arrest per year in England. The outcomes were costs (in 2019 £) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results.ResultsIn a simulated cohort of 1,000 patients who need TTM, the Thermogard XP resulted in direct cost savings of £2,339 and £2,925 (per patient) when compared with Blanketrol III and Arctic Sun 5000 respectively, and a gain of 0.98 QALYs over the patient lifetime. Total cost saving considering cohort of 1,000 patients is £2,339,479 and £ 2,925,109 when using IVTM through Thermogard XP compared with Blanketrol III and Arctic Sun 5000 respectively in life-time horizon. Results were robust against alternative assumptions, changes in values of input parameters, and alternative time horizons.ConclusionImplementation of intravascular temperature management using Thermogard XP can lead to cost-savings and improvement in patients’ quality of life versus surface cooling methods.

As a recognized therapy to improve airway clearance, high-frequency chest wall oscillation (HFCWO) is used to manage reduced vital capacity in patients with complex neuromuscular disorders (cNMD). This study aimed to investigate the budget impact of HFCWO versus chest wall physical therapy (CWPT) from a US-commercial payer perspective. In combination with a previously developed cost-effectiveness model, a budget impact model was developed to evaluate the incremental budgetary impact associated with introducing a HFCWO device over a 5-year time horizon. The model compared the cost implications associated with the commonly used CWPT procedure, as the current scenario, with a new scenario consisting of 80% of market share for HFCWO. The resource use and costs included in the analyses were costs associated with the HFCWO device (Vest™ System) and its consumables, patient training, and medical services such as hospitalization, medications, emergency room, and outpatient visits. The primary outcome measures included total and incremental budgetary impact per member per year (PMPY). In a hypothetical plan of 1,000,000 members (men: 49.2%), 2099 patients with cNMD were estimated to be eligible to receive airway clearance services over 5 years. The new scenario (HFCWO and CWPT [US$24 PMPY]) was cost-saving compared with the current scenario (CWPT only [$34 PMPY]) with a cost reduction of US$9.46 PMPY. The model estimated a net cost-saving of US$1,594,131 and US$9,591,343 over 1 and 5 years, respectively. This study suggests the HFCWO technique to manage the reduction in vital capacity in patients with cNMD would lead to favorable budget impact results.

Background Coronary artery disease (CAD) is the most common type of heart and circulatory disease and is the leading cause of death worldwide. The current diagnostic pathway can lead to patient complications and is also extremely costly. A new medical device, the CADScor System (Acarix AB), was developed for the acoustic detection of CAD before patients undergo invasive diagnostic procedures. Objectives Our objective was to assess the cost utility of the CADScor System for the diagnosis of CAD at an early stage in the diagnostic testing pathway in England. Methods A two-part economic model, consisting of a decision tree and Markov model, was developed to consider the cost utility (cost per quality-adjusted life-year [QALY] gained) of introducing the CADScor System for the diagnosis of CAD. The decision tree component explored the short-term costs and diagnostic outcomes associated with introduction of the test compared with the existing testing pathway. A Markov model was developed to explore the longer-term health and economic implications of the condition and original diagnosis, with costs and health effects estimated over different time horizons. Parameter uncertainty was explored in deterministic and probabilistic sensitivity analyses. Results Base-case results indicated that the CADScor System would result in cost savings (− £131 per patient) and a marginal increase in QALYs (0.00001) over a 1-year time horizon. Probabilistic results indicated that the intervention had a > 99% probability of being cost effective at a willingness-to-pay threshold of £20,000 per QALY gained and 100% probability of being cost saving. Results from the deterministic sensitivity analyses indicated that variations in parameters related to the accuracy and cost of the CADScor System, and the prevalence of CAD, had the greatest impact on the overall results. The overall cost saving was estimated to be over £12.3 million per 100,000 eligible patient population. Conclusions The CADScor System is a potentially cost-saving test for the diagnosis of CAD. When initiated before the use of non-invasive cardiac imaging tests such as computed tomography coronary angiography, the test reduced costs to the healthcare service over various time horizons. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-021-00297-0.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040 . 1

Background Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. Objectives To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3–4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. Methods A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. Results Base-case results indicate that the intervention leads to cost savings (− £435) and improved effectiveness (+ 0.028 QALYs) over the patient’s lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. Conclusions The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3–4 undergoing angiographic procedures. Electronic supplementary material The online version of this article (10.1007/s41669-020-00195-x) contains supplementary material, which is available to authorized users.

Sound lateralization/localization is one of the most important auditory processing abilities, which plays approved role in auditory streaming and speech perception in challenging situations like noisy places. In addition to the main role of lower brainstem centers like superior olivary complex in sound lateralization, efferent auditory system effects on improving auditory skills in everyday auditory challenging positions were revealed. This study evaluated noise effects on lateralization scores in correlation with an objective electrophysiologic test (Speech-ABR in noise), which objectively shows cumulative effects of the afferent and efferent auditory systems at the inferior colliculus and upper brainstem pathway. Fourteen normal-hearing subjects in the age range of 18 to 25 participated in this study. Lateralization scores in the quiet and noisy modes were evaluated. Speech-ABR in both ears for quiet mode and three different contralateral noise levels (SNR = + 5, 0, − 5) were recorded, too. Correlation of lateralization scores and Speech-ABR changes in noise was studied. Significant decrease of lateralization scores with latency increase and amplitude decrease of Speech-ABR transient peaks (V, A, O) was seen with noise presentation. A high positive correlation between lateralization decrease with latency increase of onset peaks (V, A) and amplitude decrease of transient peaks (V, A, O) was found in low signal-to-noise ratios. The study revealed that in high challenging auditory situations like auditory lateralization in noise, upper brainstem centers and pathways play a facilitative role for main auditory lateralization centers in lower levels.

Introduction:Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU. Materials &Methods: Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded. Results:Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients. Conclusions:Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.

Background Acute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery. Objective The aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK. Methods A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters. Results In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators—delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53–77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit. Conclusions The implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use. Electronic supplementary material The online version of this article (10.1007/s41669-019-00183-w) contains supplementary material, which is available to authorized users.

Schistosomiasis afflicts an estimated 10 million pregnant women in Africa annually. With mounting evidence of adverse impacts to reproductive health resulting from urogenital schistosomiasis, including increased transmission of HIV, further research on prenatal disease epidemiology is warranted, with implications for maternal and fetal health. Between October 2016 and March 2017, we conducted a cross-sectional study examining the prevalence of urogenital schistosomiasis and its association with sexually transmitted infections (STIs) other than HIV among pregnant women visiting antenatal clinics in Kisantu health zone, Democratic Republic of Congo. An extensive sociodemographic and clinical survey was administered to consenting participants, with urine samples and vaginal swabs collected to deduce active schistosomiasis and STIs, respectively. In total, 17.4% of expectant mothers were infected with Schistosoma haematobium, 3.1% with Chlamydia trachomatis (CT), 1.4% with Neisseria gonorrhoeae (NG), and 14.6% with Trichomonas vaginalis (TV). Women infected with urogenital schistosomiasis were at significantly increased odds of harboring a CT, NG, or TV infection (adjusted odds ratio = 3.0, 95% CI: 1.5, 6.0), but reports of clinical symptoms were low, ranging from 17.2% of schistosomiasis to 30.8% of TV cases. Laboratory confirmation of schistosomiasis and STIs provided objective evidence of disease in a cohort with low symptomology where syndromic management may not suffice. Shedding light on local risk factors and associated coinfections of urogenital schistosomiasis can identify unique intervention opportunities for prenatal care in trematode-endemic regions and aid in reducing adverse pregnancy outcomes.

The reduction of brain-derived neurotrophic factor (BDNF) affects cognitive function, learning, and memory and also causes behavioral disorders. Several randomized controlled trials have examined the neuroprotective effects of curcumin and its ability to increase BDNF levels, with inconclusive results. The aim of this systematic review was to evaluate the impact of curcumin supplementation on serum BDNF levels. A systematic review of the literature was conducted using PubMed, Scopus, ISI Web of Science, Cochrane library, and Google scholar to identify eligible studies up to January 2019. The studies included were randomized control trials of curcumin supplementation that reported the serum BDNF level as a primary outcome. A dose-response meta-analysis of eligible studies was performed using the random-effects model to estimate pooled effect size. Four randomized control trials with 139 participants were included. Curcumin supplementation dose and duration ranged from 200 to 1820 mg/d and 8 to 12 weeks, respectively. Curcumin supplementation significantly increased serum BDNF levels (weighted mean difference: 1789.38 pg/mL, 95% confidence interval: 722.04-2856.71, P

Diabetes increases the odds of depression and depression is often associated with poor glycemic control and complications of diabetes. Vitamin D is also believed to improve glycemic control and ameliorate depressive symptoms. Therefore, we examined effects of vitamin D monotherapy (without antidepressant drugs) on depressive symptoms in Type 2 diabetic patients with mild to moderate depressive symptoms.We conducted 12 weeks, placebo-controlled, double-blind, randomized trial on 68 subjects with T2DM and mild to moderate depressive symptoms. Subjects received 100 μg (4000 IU) vitamin D (n = 32) or placebo (n = 34) daily. Beck Depression Inventory-II (BDI-II-PERSIAN) was applied for assessment of the severity of depression. Depression scores and metabolic profiles were measured at the beginning and end of trail.after 3 months of vitamin D supplementation, mean values of 25(OH) D increased from 15.5 ± 8.8 to 32.2 ± 8.9 ng/ml (p-value0.001) in the vitamin D group. Moreover, BDI-II scores decreased from 15.2 ± 9.6 to 9.8 ± 7.2 (p-value0.001) in the vitamin D group and 15.5 ± 11.2 to 13.7 ± 11.5 (p-value = 0.03) in placebo group. This decrease in BDI-II scores were significant (27.6% vs 10.8%) compared with placebo (p-value = 0.02). In term of metabolic profiles, mean change in level of Hemoglobin A1c (HbA1c), insulin and triglycerides (TG) were significantly higher in response to the treatment with vitamin D compared to placebo (p-value0.02).In conclusion, supplementation of vitamin D in T2DM patients may protect these patients against the onset of major depressive disorder (MDD), with noticeable favorable effects on measures of metabolic profiles.NCT03008057.

Individuals born between 1945 and 1965 (“baby boomers”) account for an estimated three quarters of all hepatitis C (HCV) infections in the United States. This article describes the evaluation of Test4HepC, a program that uses social media and a website to promote HCV testing to baby boomers in Los Angeles County, California. The first 16 months of Test4HepC were evaluated using an online survey (n = 302), qualitative interviews (n = 20), website and social media analytics, and records of free testing offered though the program. Test4HepC.org had 6,919 visitors; 48 individuals used the free testing offered. Within 1 month of visiting the website, 24.5% (74) of survey participants tested for HCV, 67.6% (50) received a negative HCV antibody test result, 2.7% (2) received a positive HCV antibody test result, and 25.7% (19) had not received their results as of taking the survey. Most of those not tested (60.5%) reported intention to test. In multivariable analysis, male sex and high perceived usefulness of the program website were associated with HCV testing. Qualitative interviews suggested that Test4HepC increased baby boomers’ HCV risk perception and encouraged testing. Social media is a promising strategy for promoting HCV testing to baby boomers. Expanding Test4HepC to other areas and prioritizing the highest risk baby boomers could enable many people with HCV to benefit from new treatments.

Objective The aim of this study was to assess the cost-effectiveness of pressurized intraperitoneal aerosol chemotherapy with low-dose cisplatin and doxorubicin (PIPAC C/D) for the treatment of advanced gastric cancer. Methods A Partitioned Survival Model followed by state transition Markov model was developed to estimate the costs and effectiveness of the use of PIPAC C/D versus palliative chemotherapy in the UK. The intervention was assessed at two different levels of care, including upfront therapy (PIPAC C/D plus Oxaliplatin in combination with Capecitabine (XELOX) chemotherapy versus first-line chemotherapy alone) and second-line therapy (PIPAC C/D alone versus second-line chemotherapy (ramucirumab monotherapy)). Data from multiple sources, including published literature and UK-based databases, were used to inform the economic model. Results For the upfront therapy analysis, the estimated total costs in the intervention and comparator arms were £32,606 (SD: £3877) and £17,844 (SD: £920), respectively. PIPAC C/D plus XELOX led to an increase of 0.46 in quality-adjusted life-years (QALYs) gained. The incremental cost per QALY gained was £31,868. For the second-line therapy analysis, the use of PIPAC C/D led to an increase of 0.19 in QALYs and a £21,474 reduction in costs, meaning the intervention was a dominant strategy. Conclusions The cost-effectiveness results for the upfront therapy analysis indicate that PIPAC C/D plus chemotherapy is a cost-effective strategy. Additionally, PIPAC C/D alone as a second-line therapy has the potential to reduce costs and improve clinical outcomes for patients with advanced gastric cancer with peritoneal metastasis.

Background and Aim: The majority of the world’s population is bilingual. Bilingualism is a form of sensory enrichment that translates to gains in cognitive abilities; these cognitive gains in attention and memory are known to modulate subcortical processing of auditory stimuli. Sec­ond language acquisition has a broad impact on various psychological, cognitive, memory, and linguistic processes. Central auditory processing (CAP) is the perceptual processing of auditory information. Due to its importance in bilingu­alism, this study aimed to review the CAP of bilinguals. Recent Findings: The CAP was studied in three areas: dichotic listening, temporal processing, and speech in noise perception. Regarding dicho­tic listening, studies have shown that bilinguals have better performance in staggered spondaic word (SSW) test, consonant-vowel dichotic test, dichotic digits test (DDT), and disyllable dichotic test than monolinguals, although similar results have also been reported in SSW and DDT. Reg­arding temporal processing, the results of bilin­guals do not differ from those of monolinguals, although in some cases, it is better in bilinguals. Regarding speech in noise perception, the results between bilinguals and monolinguals are varied depending on the amount of linguistic infor­mation available in the stimuli. Conclusion: Bilingualism has a positive effect on dichotic processing, no effect on temporal processing, and varied effect on speech in noise perception. Bilinguals have poor performance using meaningful speech and better performance using meaningless speech. Keywords: Central auditory processing; bilingual; dichotic listening; temporal processing; speech in noise perception

Background. There is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill COVID-19 patients is still provisional and further investigations are needed to confirm its eventual beneficial effects. Methods. We therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with diagnosis of COVID-19 pneumonia confirmed by real-time polymerase chain reaction (RT-PCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard of care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir); and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 liter of patients’ plasma by a solution, 50% of normal plasma and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint. Results. Deaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of Structural Equation Modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name “severity”). Disease severity was significantly (Wilkinson rank sum test p-value=0.0000) lower among COVID-19 patients undergoing TPE (median: -2.82; range: -5.18; 7.96) as compared to those non receiving TPE (median: -1.35; range: -3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as covariate in Cox regression models. The univariate Hazard Ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p=0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p=0.741) after adjusting for severity. Conclusions. The lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than TPE effects. TRIAL REGISTRATIONIRCT registration number: IRCT20080901001165N58 (Iranian Registry of Clinical Trials)Registration date: 2020-05-27, 1399/03/07 (retrospectively registered)

BACKGROUND: The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated. RESULTS: The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams. CONCLUSIONS: Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Background Substance use decreases the likelihood of achieving undetectable HIV viremia; however, the comparative effects by drug have not been fully described. In this study, we compare the effects of methamphetamine use versus other drugs on viremia in sexual minority men on antiretroviral therapy (ART). Methods HIV-positive participants currently on ART (N = 230) were selected from an ongoing cohort of diverse young sexual minority men (mSTUDY) enrolled from August 2014 to May 2018. Substance use and sociodemographic factors associated with viremia outcomes were assessed using ordinal regression analysis with generalized estimating equations. Viremia outcomes were grouped as undetectable ( 20 copies/mL), low level suppressed (21–200 copies/mL), or not suppressed (>200 copies/mL). Results The prevalence of drug use across 825 study visits was 73 %, with methamphetamine use most prevalent (50 %). After adjusting for unstable housing and ART adherence, methamphetamine use, either alone (adjusted OR = 1.87; 95 % CI 1.03−3.40) or with other drugs (adjusted OR = 1.82; 95 % CI 1.12−2.95), was associated with higher odds of increasing viremia compared to no drug use. Other drug use excluding methamphetamine did not show a similar association (adjusted OR = 1.29; 95 % CI 0.80−2.09). Among our study population, nearly half the instances of viremia could be reduced if methamphetamine was discontinued (attributable fraction = 46 %; 95 % CI 3–71 %). Conclusions Methamphetamine use, either alone or in combination with other drugs, is associated with failure of viral suppression among sexual minority men on ART independent of adherence and sociodemographic factors. This accounts for nearly half of the observed instances of unsuppressed viremia in this study.

Background The Paramedic Acute Stroke Treatment Assessment (PASTA) trial evaluated an enhanced emergency care pathway which aimed to facilitate thrombolysis in hospital. A pre-planned health economic evaluation was included. The main results showed no statistical evidence of a difference in either thrombolysis volume (primary outcome) or 90-day dependency. However, counter-intuitive findings were observed with the intervention group showing fewer thrombolysis treatments but less dependency. Aims Cost-effectiveness of the PASTA intervention was examined relative to standard care. Methods A within trial cost-utility analysis estimated mean costs and quality-adjusted life years over 90 days’ time horizon. Costs were derived from resource utilization data for individual trial participants. Quality-adjusted life years were calculated by mapping modified Rankin scale scores to EQ-5D-3L utility tariffs. A post-hoc subgroup analysis examined cost-effectiveness when trial hospitals were divided into compliant and non-compliant with recommendations for a stroke specialist thrombolysis rota. Results The trial enrolled 1214 patients: 500 PASTA and 714 standard care. There was no evidence of a quality-adjusted life year difference between groups [0·007 (95% CI: −0·003 to 0·018)] but costs were lower in the PASTA group [−£1473 (95% CI: −£2736 to −£219)]. There was over 97.5% chance that the PASTA pathway would be considered cost-effective. There was no evidence of a difference in costs at seven thrombolysis rota compliant hospitals but costs at eight non-complaint hospitals costs were lower in PASTA with more dominant cost-effectiveness. Conclusions Analyses indicate that the PASTA pathway may be considered cost-effective, particularly if deployed in areas where stroke specialist availability is limited. Trial Registration: ISRCTN12418919 www.isrctn.com/ISRCTN12418919

Publisher´s version (útgefin grein)., Background Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.Methods We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer’s disease and other dementias, Parkinson’s disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.Findings Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer’s and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer’s disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).Interpretation Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies., ROA is funded by the National Institutes of Health (U01HG010273). SMA acknowledges the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project. AAw acknowledges funding support from Department of Science and Technology, Government of India, New Delhi, through INSPIRE Faculty scheme. TBA acknowledges partial funding from the Institute of Medical Research and Medicinal Plant Studies. ABa is supported by the Public Health Agency of Canada. TWB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor Award, funded by the Federal Ministry of Education and Research. MSBS acknowledges support from the Australian Government Research and Training Program scholarship for a PhD degree at the Australian National University, Australia. JJC is supported by the Swedish Heart and Lung Foundation. FCar is supported by the European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundacao para a Ciencia e a Tecnologia and Ministerio da Educacao e Ciencia) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020UID/QUI/50006/2013. EC is supported by an Australian Research Council Future Fellowship (FT3 140100085). KD is supported by a Wellcome Trust [Grant Number 201900] as part of his International Intermediate Fellowship. EF is supported by the European Union (FEDER funds POCI/01/0145/FEDER/007728 and POCI/01/0145/FEDER/007265) and National Funds (FCT/MEC, Fundacao para a Ciencia e a Tecnologia and Ministerio da Educacao e Ciencia) under the Partnership Agreements PT2020 UID/MULTI/04378/2013 and PT2020UID/QUI/50006/2013. SMSI is funded by the Institute for Physical Activity and Nutrition (IPAN), Deakin University and received funding from High Blood Pressure Research Council of Australia. YKa is a DBT/Wellcome Trust India Alliance Fellow in Public Health. YJK is supported by the Office of Research and Innovation at Xiamen University Malaysia. BL acknowledges funding from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. WDL is supported in part by U10NS086484 NINDS. SLo is funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1411A). RML is supported by a National Health and Medical Research Council (NHMRC) of Australia Senior Research Fellowship. AMa and the Imperial College London are grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research and Care. JJM is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the John Cade Fellowship (APP1056929) from NHMRC. TMei acknowledges additional institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena-Halle-Leipzig. IMV is supported by the Sistema Nacional de Investigacion (Panama). MOO is supported by SIREN U54 U54HG007479 and SIBS Genomics R01NS107900 grants. AMS was supported by a fellowship from the Egyptian Fulbright Mission Program. MMSM acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (contract no 175087). AShe is supported by Health Data Research UK. MBS' work on traumatic brain injury is supported by grants NIH U01 NS086090 (PI G Manley) from the National Institutes of Health (NIH) and DoD W81XWH-14-2-0176 (PI G Manley) from the United States Department of Defense. RTS is supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIIIFEDER. AGT was supported by a Fellowship from the NHMRC (Australia; 1042600. KBT acknowledges funding supports from the Maurice Wilkins Centre for Biodiscovery, Cancer Society of New Zealand, Health Research Council, Gut Cancer Foundation, and the University of Auckland. CY acknowledges support from the National Natural Science Foundation of China (grant number 81773552) and the Chinese NSFC International Cooperation and Exchange Program (grant number 71661167007)., "Peer Reviewed"

Background: Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health. Methods: Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed. Results: Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis. Discussion: Findings suggest that refugees’ perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

Objective Herpes simplex virus (HSV), as a common infection in healthy individuals, is treated symptomatically, but drug resistance and the side effects of drugs have drawn the attention of researchers to complementary medicine. Olive Leaf Extract (OLE) has antiviral effects that may treat HSV. The current study aimed to compare the clinical effects of OLE and Acyclovir on HSV-1. Methods This randomized double-blind clinical trial was conducted on 66 patients who had already been diagnosed with HSV-1. The participants were randomized into two groups, receiving 2% OLE cream or 5% acyclovir cream five times a day for six days. The symptoms were evaluated before, and three and six days after the interventions. Data were analyzed using the SPSS software through the Kolmogorov-Smirnov test, chi-squared, t-test, and repeated measures ANOVA. Results The results showed clinical symptoms decreased in both groups during the study and both medications were effective in the treatment of HSV-1. However, the OLE group experienced less bleeding (P = 0.038), itching (P = 0.002), and pain (P = 0.001) on the third day as well as less irritation (P = 0.012), itching (P = 0.003) and color change (P = 0.001) on the sixth day compared to the acyclovir group. The treatment course for participants in the OLE group was shorter than in the acyclovir group (P = 0.001). Conclusion The evidence from these trials suggests the OLE cream is superior in the healing of episodes of HSV-1 over the acyclovir cream. Future studies are recommended to investigate if OLE could be an adjunct to acyclovir treatment.

We present a critically ill patient affected by COVID-19, whose chest computed tomography (CT) scan featured lung consolidations and severe patchy ground-glass opacitie. On day 3 since hospital admission the patient was placed on convalescent plasma treatment. A combined treatment with supportive care, hemoperfusion and convalescent plasma successfully managed to save the patient's life. Convalescent plasma probably contributed to heal this patient and should always be considered in the management of critically ill COVID-19 cases.

Background Prevalence of methamphetamine (meth) injection and associated human immunodeficiency virus (HIV) risks among men who have sex with men (MSM) are unclear. Methods A total of 532 MSM completed 1880 mSTUDY study visits between August 2014 and June 2018 in Los Angeles, California. Assessments every 6 months included computer-assisted self-interviews and testing for sexually transmitted infections. Analyses by person and across visits adjusted for repeated measures. Results Of 532 participants, 51% (n = 276) reported meth use (past 6 months). Across 1880 visits, mutually exclusive substance use categories were as follows: 5% meth injection (5%), meth use without injection (33%), other substance use excluding meth (36%), and no substance use (26%). Comparisons across these categories respectively found that meth injectors reported higher prevalence of new sex partners (89%, 70%, 68%, and 51%, respectively), more were HIV positive (83%, 65%, 34%, and 50%), fewer were virally suppressed (53%, 48%, 61%, and 67%), and more had sexually transmitted infections (31%, 22%, 15%, and 15% (all P Conclusions Among the young MSM reporting meth injection in this Los Angeles cohort, elevated risks of acquiring or transmitting HIV suggest that they contribute significantly to sustaining the local HIV epidemic. Preventing transition to injection use has potential for HIV prevention.

Coronavirus disease 2019 (COVID-19) is a pandemic impacting 213 countries and territories with more than 17,918,582 cases worldwide. Kidney dysfunction has been reported to occur in severe and death cases. This meta-analysis was done to summarize available studies on the association between acute kidney injury and severity of COVID-19 infection. Online databases including Web of Science, PubMed/Medline, Cochrane Library, Scopus and Google Scholar were searched to detect relevant articles up to 1 July 2020, using relevant keywords. To pool data, a random- or fixed-effects model was used based on the heterogeneity between studies. In total, 50 studies with 8,180 COVID-19 confirmed cases (severe cases=1,823 and death cases=775), were included in this meta-analysis. Higher serum levels of creatinine (weighted mean difference (WMD) for disease severity=5.47 μmol/L, 95% CI=2.89 to 8.05, P2, 95% CI=-18.46 to -12.22, P2, 95% CI=-27.18 to -18.31, P

Importance The re-opening of colleges and universities through the US during the COVID-19 pandemic is a significant public health challenge. The development of accessible and practical approaches for SARS-CoV-2 detection in the college population is paramount for deploying recurrent surveillance testing as an essential strategy for virus detection, containment, and mitigation. Objectives In this study, we set out to determine the prevalence of SARS-CoV-2 in asymptomatic subjects in a university community, using, for the first time, CREST, a CRISPR-Cas13-based test that we developed for accessible and large scale viral surveillance1. Study Design, Setting, and Participants We enrolled 1,808 asymptomatic persons to undergo SARS-CoV-2 testing. We compared viral prevalence in self-collected oropharyngeal swab samples obtained in two time periods: May 28th-June 11th and June 23rd-July 2nd, 2020. We detected viral genomes in these samples using CREST, and we corroborated our results with a point-of-reference RT-qPCR test. Positive samples were confirmed by a clinical laboratory and reported to the local Public Health Department. Results All the 732 tests performed between late May to early June were negative. In contrast, tests performed on 1,076 samples collected between late June to early July revealed eight positive cases by CREST, confirmed by RT-qPCR and CLIA-diagnostic testing. The average age of the positive cases was 21.7 years; all individuals self-identified as students. These metrics showed that CREST was effective at capturing positive SARS-CoV-2 cases in our student population. Notably, the viral loads detected in these asymptomatic cases resemble those seen in clinical samples, highlighting the potential of covert viral transmission. Conclusions and Relevance Our study revealed a substantial shift in SARS-CoV-2 prevalence in a young and asymptomatic population, and uncovered the leading wave of a local outbreak that coincided with rising case counts in the surrounding county and the state of California. Moreover, and most notably, the almost perfect concordance between CRISPR- and PCR-based testing indicated that CREST using self-collected OP swabs is reliable and it allows expanding options for large-scale surveillance testing and detection of SARS-CoV-2 outbreaks, as is required to resume operations in higher education institutions in the US and abroad. Key Points Question Are CRISPR-based methods a reliable and accessible option to capture SARS-CoV-2 outbreaks in a college population? Findings We tested 1,808 asymptomatic individuals from a university population for SARS-CoV-2, using, for the first time, a CRISPR-based assay for virus surveillance. We detected eight positive cases, corroborated by RT-qPCR and confirmed by a clinical laboratory. Our CRISPR-based method captured a change in viral prevalence coinciding with the relaxation of lockdown measures and the rise of COVID-19 cases in the community. Significance We demonstrate that CRISPR-based methods offer scalable and reliable SARS-CoV-2 testing for virus surveillance and allow capturing the leading edge of an outbreak.

Despite widespread prevalence of lubricant use and rectal douching for receptive anal intercourse (RAI) among men who have sex with men (MSM), research evaluating the association of these behaviors with sexually transmitted infections (STIs) is limited. This is an observational analysis of a longitudinal cohort of predominantly Black/Latino MSM in Los Angeles. Every six months from August 2014 to January 2018, participants received STI screening and surveys evaluating lubricant use, douching, substance use, and sexual risk behaviors. General estimating equations evaluated the association between consistent lubricant use and douching for RAI with positive rectal Neisseria gonorrhoeae, Chlamydia trachomatis, and/or syphilis (positive STI). Among 313 participants across 552 study visits, 16.5% (91/552) had positive STI. Consistent lubricant use was reported in 52.7% (243/552) and rectal douching in 57.6% (318/552) of study visits. Consistent lubricant use was associated with STI diagnosis (adjusted OR [AOR] 1.81; 95% CI 1.11–2.96; p = 0.018). Each episode of rectal douching before RAI was associated with 2% increased odds of positive STI (AOR 1.02; 95% CI 1.00–1.04; p = 0.041). Among this cohort of HIV-positive and high-risk HIV-negative MSM, lubricant use and douching was common and independently associated with an STI, suggesting the utility of prevention messaging around barrier methods/condoms for sexual encounters involving douching/lubricant use.

Background: Nonmelanoma skin cancers are the most frequently occurring skin cancers. Vitamin A is involved in epithelial cell differentiation and may control skin tumor development. Vitamin E is a powerful lipophilic antioxidant that can quench and scavenge reactive oxygen species. However, there is little consistent evidence considering micronutrients and the development of basal cell carcinoma (BCC). Therefore, we aimed to investigate the possible difference between retinol and α-tocopherol in BCC patients and controls in Iranian population. Methods: This case-control study was conducted on adults with newly diagnosed BCC referred to Razi Hospital, Tehran, Iran in 2015. Serum and subcutaneous fat tissue retinol and α-tochopherol were measured by HPLC method. Results: Overall, serum retinol level was lower significantly in BCC patients (0.237±0.01 µg/ml) in comparison with control group (0.27±0.02 µg/ml, P-value: 0.038). However serum ɑ-tocopherol level was not significantly different between BCC patients (4.41±0.33 µg/ml) and control subjects (4.06±0.35 µg/ml, P-value=0.18). Subcutaneous adipose tissue retinol was lower significantly in BCC patients (38.60±3.30 ng/mg) compared with control group (54.78±3.49 ng/mg, P-value=0.002). Furthermore, results revealed lower subcutaneous adipose tissue ɑ-tocopherol in BCC patients (4.41±0.33 µg/ml) in comparison with control group (4.06±0.35 µg/ml, P-value=0.18). Conclusion: Skin tissue concentration of retinol and ɑ-tocopherol and serum retinol level was lower in BCC patients in comparison with control group but serum ɑ-tocopherol was not different between groups.

Resumo Fundamento Os glicocorticóides (GCs) são amplamente prescritos para o tratamento de numerosos distúrbios clínicos devido às suas propriedades anti-inflamatórias e imunomoduladoras, e um dos efeitos indesejáveis mais comuns desses medicamentos é a dislipidemia. Objetivo Avaliar o efeito da quercetina, um flavonoide derivado de plantas, no perfil lipídico de ratos tratados com glicocorticóides em altas doses. Métodos Um total de 32 ratos Sprague-Dawley foram distribuídos aleatoriamente entre quatro grupos (8 ratos por grupo) e tratados por 6 semanas com uma das seguintes opções : (i) solução salina normal; (ii) 40 mg/kg de succinato sódico de metilprednisolona (MP); (iii) MP + 50 mg/kg de quercetina; (iv) MP + 150 mg/kg de quercetina. O MP foi injetado por via subcutânea e a quercetina foi administrada por gavagem oral 3 dias por semana. No final do estudo, o perfil lipídico dos animais foi medido através de kits enzimáticos. Os dados foram analisados e a significância estatística foi estabelecida em p

ObjectivesStress urinary incontinence (SUI) and stress-predominant mixed urinary incontinence (MUI) are common conditions that can have a negative impact on the quality of life of patients and serious cost implications for healthcare providers. The objective of this study was to assess the cost-effectiveness of nine different surgical interventions for treatment of SUI and stress-predominant MUI from a National Health Service and personal social services perspective in the UK.MethodsA Markov microsimulation model was developed to compare the costs and effectiveness of nine surgical interventions. The model was informed by undertaking a systematic review of clinical effectiveness and network meta-analysis. The main clinical parameters in the model were the cure and incidence rates of complications after different interventions. The outcomes from the model were expressed in terms of cost per quality-adjusted life-years (QALYs) gained. In addition, expected value of perfect information (EVPI) analyses were conducted to quantify the main uncertainties facing decision-makers.ResultsThe base-case results suggest that retropubic mid-urethral sling (retro-MUS) is the most cost-effective surgical intervention over a 10-year and lifetime time horizon. The probabilistic results show that retro-MUS and traditional sling are the interventions with the highest probability of being cost-effective across all willingness-to-pay thresholds over a lifetime time horizon. The value of information analysis results suggest that the largest value appears to be in removing uncertainty around the incidence rates of complications, the relative treatment effectiveness and health utility values.ConclusionsAlthough retro-MUS appears, at this stage, to be a cost-effective intervention, research is needed on possible long-term complications of all surgical treatments to provide reassurance of safety, or earlier warning of unanticipated adverse effects. The value of information analysis supports the need, as a first step, for further research to improve our knowledge of the actual incidence of complications.