Endoscopic retrograde appendicitis therapy vs. Laparoscopic appendectomy for uncomplicated acute appendicitis

Background and study aims: To assess the efficacy and clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT) versus laparoscopic appendectomy (LA) for patients with uncomplicated acute appendicitis (AA). Patients and methods: We adopted propensity score matching (1:1) to compare ERAT and LA patients with uncomplicated AA from April 2017 to March 2020. We reviewed a total of 2880 patients with suspected acute appendicitis, of whom 422 patients with uncomplicated AA met the matching criteria (ERAT, 79; LA, 343), yielding 78 pairs of patients. Results: The rate of curative treatment within one year after ERAT was 92.1%; 95% CI, [83.8% - 96.3%]. The percentage of Visual Analog Scale (VAS) ≤ 3 at six hours after treatment was 94.7%; 95% CI [87.2% - 97.9%] in the ERAT group, and significantly higher than that in the LA group 83.3%; 95% CI [73.5% - 90.0%]. Median operative/procedure time and median hospital length of stay in the ERAT group were significantly lower compared to the LA group. At one year, the median recurrence time was 50 days (IQRs, 25-127) in the ERAT group. The overall adverse event rate was 24.3%; 95% CI [14.8% - 33.9%] in the LA group and 18.4%; 95% CI [9.7% - 27.1%] in the ERAT group, with no significant difference between the two groups. Conclusions: ERAT is a technically feasible method to treat uncomplicated AA compared to LA.

Humoral response to SARS-CoV-2 infection among liver transplant recipients

ObjectiveImmunosuppressive agents are known to interfere with T and/or B lymphocytes, which are required to mount an adequate serologic response. Therefore, we aim to investigate the antibody response to SARS-CoV-2 in liver transplant (LT) recipients after COVID-19.DesignProspective multicentre case–control study, analysing antibodies against the nucleocapsid protein, spike (S) protein of SARS-CoV-2 and their neutralising activity in LT recipients with confirmed SARS-CoV-2 infection (COVID-19-LT) compared with immunocompetent patients (COVID-19-immunocompetent) and LT recipients without COVID-19 symptoms (non-COVID-19-LT).ResultsOverall, 35 LT recipients were included in the COVID-19-LT cohort. 35 and 70 subjects fulfilling the matching criteria were assigned to the COVID-19-immunocompetent and non-COVID-19-LT cohorts, respectively. We showed that LT recipients, despite immunosuppression and less symptoms, mounted a detectable antinucleocapsid antibody titre in 80% of the cases, although significantly lower compared with the COVID-19-immunocompetent cohort (3.73 vs 7.36 index level, p<0.001). When analysing anti-S antibody response, no difference in positivity rate was found between the COVID-19-LT and COVID-19-immunocompetent cohorts (97.1% vs 100%, p=0.314). Functional antibody testing showed neutralising activity in 82.9% of LT recipients (vs 100% in COVID-19-immunocompetent cohort, p=0.024).ConclusionsOur findings suggest that the humoral response of LT recipients is only slightly lower than expected, compared with COVID-19 immunocompetent controls. Testing for anti-S antibodies alone can lead to an overestimation of the neutralising ability in LT recipients. Altogether, routine antibody testing against separate SARS-CoV-2 antigens and functional testing show that the far majority of LT patients are capable of mounting an adequate antibody response with neutralising ability.

Cost-Utility of an Online Education Platform and Diabetes Personal Health Record: Analysis Over Ten Years

Background and Aims: My Diabetes My Way (MDMW) is Scotland’s interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. Materials and Methods: Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. Results: MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: –£118.72 (–£150.16 to –£54.16) over ten years. Increasing MDMW costs (10%): –£50.49 (–£82.24-£14.14). Decreasing MDMW costs (10%): –£186.95 (–£218.53 to –£122.51). Conclusions: MDMW is “dominant” over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.

Reduced Odds of SARS-CoV-2 Reinfection after Vaccination among New York City Adults, June–August 2021

BackgroundBelief in immunity from prior infection and concern that vaccines might not protect against new variants are contributors to vaccine hesitancy. We assessed effectiveness of full and partial COVID-19 vaccination against reinfection when Delta was the predominant variant in New York City.MethodsWe conducted a case-control study in which case-patients with reinfection during June 15– August 31, 2021 and control subjects with no reinfection were matched (1:3) on age, sex, timing of initial positive test in 2020, and neighborhood poverty level. Conditional logistic regression was used to calculate matched odds ratios (mOR) and 95% confidence intervals (CI).ResultsOf 349,598 adult residents who tested positive for SARS-CoV-2 infection in 2020, did not test positive again >90 days after initial positive test through June 15, 2021, and did not die before June 15, 2021, 1,067 were reinfected during June 15–August 31, 2021. Of 1,048 with complete matching criteria data, 499 (47.6%) were known to be symptomatic for COVID-19-like-illness, and 75 (7.2%) were hospitalized. Unvaccinated individuals, compared with fully vaccinated individuals, had elevated odds of reinfection (mOR, 2.23; 95% CI, 1.90, 2.61), of symptomatic reinfection (mOR, 2.17; 95% CI, 1.72, 2.74), and of reinfection with hospitalization (mOR, 2.59; 95% CI, 1.43, 4.69). Partially versus fully vaccinated individuals had 1.58 (95% CI: 1.22, 2.06) times the odds of reinfection. All three vaccines authorized or approved for use in the U.S. were similarly effective.ConclusionAmong adults with previous SARS-CoV-2 infection, vaccination reduced odds of reinfections when the Delta variant predominated.

Lessons Learned From Translational Research in Neuromuscular Diseases: Impact on Study Design, Outcome Measures and Managing Expectation

Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD), two of the most common, child onset, rare neuromuscular disorders, present a case study for the translation of preclinical research into clinical work. Over the past decade, well-designed clinical trials and innovative methods have led to the approval of several novel therapies for SMA and DMD, with many more in the pipeline. This review discusses several features that must be considered during trial design for neuromuscular diseases, as well as other rare diseases, to maximise the possibility of trial success using historic examples. These features include well-defined inclusion criteria, matching criteria, alternatives to placebo-controlled trials and the selection of trial endpoints. These features will be particularly important in the coming years as the investigation into innovative therapy approaches for neuromuscular diseases continues.

If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia

IntroductionMaternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia.MethodsWe conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs.ResultsWe interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p<0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p<0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p<0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p<0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery.ConclusionMWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely.Trial registration numberNCT02620436.

Quantifying Substitutability

<p>In this thesis, we will tackle the problem of how keyphrase extraction systems can be evaluated to reveal their true efficacy. The aim is to develop a new semantically-oriented approximate string matching criteria, one that is comparable to human judgements, but without the cost and energy associated with manual evaluation. This matching criteria can also be adapted for any information retrieval (IR) system where the evaluation process involves comparing candidate strings (produced by the IR system) to a gold standard (created by humans). Our contributions are threefold. First, we define a new semantic relationship called substitutability – how suitable a phrase is when used in place of another – and then design a generic system which measures/quantifies this relationship by exploiting the interlinking structure of external knowledge sources. Second, we develop two concrete substitutability systems based on our generic design: WordSub, which is backed by WordNet; and WikiSub, which is backed by Wikipedia. Third, we construct a dataset, with the help of human volunteers, that isolates the task of measuring substitutability. This dataset is then used to evaluate the performance of our substitutability systems, along with existing approximate string matching techniques, by comparing them using a set of agreement metrics. Our results clearly demonstrate that WordSub and WikiSub comfortably outperform current approaches to approximate string matching, including both lexical-based methods, such as R-precision; and semantically-oriented techniques, such as METEOR. In fact, WikiSub’s performance comes sensibly close to that of an average human volunteer, when comparing it to the optimistic (best-case) interhuman agreement.</p>

Quantifying Substitutability

<p>In this thesis, we will tackle the problem of how keyphrase extraction systems can be evaluated to reveal their true efficacy. The aim is to develop a new semantically-oriented approximate string matching criteria, one that is comparable to human judgements, but without the cost and energy associated with manual evaluation. This matching criteria can also be adapted for any information retrieval (IR) system where the evaluation process involves comparing candidate strings (produced by the IR system) to a gold standard (created by humans). Our contributions are threefold. First, we define a new semantic relationship called substitutability – how suitable a phrase is when used in place of another – and then design a generic system which measures/quantifies this relationship by exploiting the interlinking structure of external knowledge sources. Second, we develop two concrete substitutability systems based on our generic design: WordSub, which is backed by WordNet; and WikiSub, which is backed by Wikipedia. Third, we construct a dataset, with the help of human volunteers, that isolates the task of measuring substitutability. This dataset is then used to evaluate the performance of our substitutability systems, along with existing approximate string matching techniques, by comparing them using a set of agreement metrics. Our results clearly demonstrate that WordSub and WikiSub comfortably outperform current approaches to approximate string matching, including both lexical-based methods, such as R-precision; and semantically-oriented techniques, such as METEOR. In fact, WikiSub’s performance comes sensibly close to that of an average human volunteer, when comparing it to the optimistic (best-case) interhuman agreement.</p>

Influence of pneumococcal conjugate vaccine 13 on upper respiratory tract microbial biodiversity in infants

Kozhakhmetov S, Aitenov Y, Ramazanova B, Koloskova Y, Burkutbayeva T, Yeraliyeva L, Mustafina K, Beglarova G, Yergazina M, Kushugulova A. 2021. Influence of pneumococcal conjugate vaccine 13 on upper respiratory tract microbial biodiversity in infants. Biodiversitas 22: 5055-5060. Pneumococcal disease and its associated mortality are burdens on the healthcare system. The intensive introduction of pneumococcal vaccines has provided robust control and infection management worldwide. The Pneumococcal Conjugate Vaccine (PCV) has been successfully employed in the national programs of many countries. However, no studies have yet analyzed the effect of pneumococcal vaccines on Central Asian populations. We investigated the effect of the pneumococcal vaccine on the nasopharyngeal microbiome of infants under the age of two years. Samples were collected from healthy patients as part of routine hospital check-ups, then subjected to high-throughput sequencing of the V1–V3 region of 16S rRNA for bioinformatics analysis. The obtained data were combined with the results of a previously published study (with matching criteria) to increase statistical power. No significant differences were found in vaccination status, sex or age. Nevertheless, the results demonstrated structural changes in the microbiome of the upper respiratory tract under the influence of the PCV13 vaccine. The results of beta-diversity unweighted UniFrac distance measuring showed that the experimental groups differed in their qualitative (taxonomic) structure (p < 0.1). In the vaccinated group, the abundance of several symbiotic taxa was significantly decreased, including Streptococcus pneumonia.

ALBUMIN CREATININE RATIO AS AN INDICATOR OF NON-HEALING FOOT WOUND FORMATION IN DIABETES

Aims: To investigate whether kidney injury, determined by albumin creatinine ratio, was associated with current non-healing foot wounds in type 2 diabetes. Materials and Methods: Eighty–nine Barbadians with diabetes were recruited. Cases had a current foot wound and controls had no current foot wound and no history of a non-healing foot wound. Cases were matched to controls using sex, age and duration of diabetes. Participants were from wound dressing and diabetes clinics at the Queen Elizabeth Hospital and Polyclinics, and from private healthcare practitioners. The relationship between albumin creatinine ratio and foot ulceration, adjusting for selected potential risk factors, was analyzed using logistic regression and presented as odds ratios. Results: Forty–four cases and 45 controls were matched, with no statistically significant difference in matching criteria. There were statistically important differences in measures of neuropathy, blood glucose, HbA1c and Albumin:creatinine ratio between cases and controls. Cases were 3 times more likely than controls to have microalbuminuria (95% CI 0.9 – 10.2; p=0.08). Cases were 7.4 times more likely than controls to have macroalbuminuria (95% CI 1.2 – 47.5; p=0.04). Conclusions: The possible association of albumin:creatinine ratio with diabetic foot wounds raises the possibility of its use in earlier identification of persons on the pathway to developing diabetic foot.