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Endocrine ◽  
2021 ◽  
Author(s):  
Bushra Shahida ◽  
Kleoniki Tsoumani ◽  
Tereza Planck ◽  
Vijayachitra Modhukur ◽  
Pernilla Asp ◽  
...  

Abstract Introduction Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO), and the link between thyroid and orbital tissue may be the presence of TSH-receptors. Radioiodine increases the titers of TRAb and the aim was to investigate the relationship between GO and TRAb titers after treatment with radioiodine and to define the impact of risk genes. Methods GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed 1 year later for the registration of GO development. The study was performed at a University Hospital Clinic; a referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were the development of TRAb, anti-TPO, and anti-TG after 3 months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, and CYR61). Results Three months of radioiodine TRAb titers increased in two thirds of patients (p < 0.0005) but not in the other third. Anti-TPO titers were associated with TRAb (R = 0.362, p < 0.0001) but not anti-TG. At follow-up 1 year later (n = 204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb titers and 30% in the group with unchanged or lower TRAb titers (p-value < 0.0005). Patients with GO had higher titers of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p < 0.005) associated with TRAb titers above the median three months after radioiodine. Conclusions The increase in TRAb titers after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher titers of TRAb.


2021 ◽  
Vol 2 ◽  
Author(s):  
Dayna Pool ◽  
Catherine Elliott ◽  
Claire Willis ◽  
Ashleigh Thornton

Objective: The objective of this study was to explore the experiences of intensive locomotor training from the perspective of therapists and parents of children with cerebral palsy.Design: A qualitative study using semi-structured interviews was employed to capture perspectives following an intensive locomotor training intervention. Data were analyzed thematically, systematically coding and interpreted by grouping information into themes and sub-theme categories.Participants: Five therapists and seven parents of children with high daily physical assistance and equipment needs participated in the study.Setting: A pediatric tertiary hospital.Results: Experiences of locomotor training were described with relation to the suitability of locomotor training with sub-themes of intervention length and time, engagement within sessions, the importance of support, and the utility of locomotor training beyond a research context. Motivation for participating in locomotor training was described in relation to the enjoyment of movement and for increasing activity level. The barriers and facilitators who participated in locomotor training provided environmental and personal factor subthemes. Finally, the outcomes from the intervention were related to improvements in physical health, sleep, affect and emotion, and ambulation in daily activities.Conclusion: The experience of intensive locomotor training from the perspectives of parents of children who have high physical assistance and equipment needs and the therapists providing the intervention was described. Future studies should consider outcome measures beyond motor capacity to quantify the perceived outcomes of interventions that are meaningful to families.


2021 ◽  
pp. archdischild-2021-322355
Author(s):  
Young June Choe ◽  
Young-Joon Park ◽  
Eun-Young Kim ◽  
Myoungyoun Jo ◽  
Eun Young Cho ◽  
...  

ObjectiveThere is an urgent public need to readdress the school closure strategies. We aimed to describe the epidemiology of COVID-19 in schools and school-aged children to understand their roles in transmitting SARS-CoV-2 in Korea.DesignRetrospective cohort study.SettingAll schools in KoreaPatientsAll school-aged children in Korea.InterventionsNone (observational study).Main outcome measuresIncidence rate, proportion of affected schools.ResultsBetween February and December 2020, the incidence rate was lower among school-aged children (63.2–79.8 per 100 000) compared with adults aged 19 and above (130.4 per 100 000). Household was the main route of transmission (62.3%), followed by community (21.3%) and school clusters (7.9%). Among the schools in Korea, 52% of secondary schools had COVID-19 cases, followed by 39% of primary schools and 3% of kindergartens.ConclusionsWe found that schools and school-aged children aged 7–18 years were not the main drivers of COVID-19 transmission. The major sources of transmission were households.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048975
Author(s):  
Huan Wang ◽  
Jianxin Guo ◽  
Tianze Wang ◽  
Kai Wang ◽  
Zhuojun Wu ◽  
...  

ObjectiveTo assess the efficacy and safety of bevacizumab (BEV) in patients with glioma.DesignSystematic review and meta-analysis.ParticipantsAdults aged 18 years and above, whose histology was confirmed to be malignant glioma.Primary and secondary outcome measuresThe main indicators included progression-free survival (PFS) rate and overall survival (OS) rate, and the secondary indicators were adverse reactions.ResultsA total of 11 clinical centre trials were included in this study for meta-analysis, including 2392 patients. The results of the meta-analysis showed that the median PFS rate of the BEV group was significantly higher than that of the non-BEV group (p<0.00001). When comparing PFS between two groups, we found that the PFS in the BEV group was higher than that in the non-BEV group at 6 months (OR 3.31, 95% CI 2.74 to 4.00, p<0.00001), 12 months (OR 2.05, 95% CI 1.70 to 2.49, p<0.00001) and 18 months (OR 1.31, 95% CI 1.02 to 1.69, p=0.03). But at 24 months (OR 0.83, 95% CI 0.50 to 1.37, p=0.47), there was no significant difference between the two groups. At 30 months (OR 0.62, 95% CI 0.39 to 0.97, p=0.04), the PFS of the BEV group was lower than that of the non-BEV group. Moreover, The results showed that BEV had no significant effect on improving OS, but the adverse reaction in BEV group was significantly higher than that in non-BEV group.ConclusionThe evidence suggests that BEV can significantly prolong the PFS of patients with glioma within 18 months and shorten the PFS of patients after 30 months. This limitation may be related to the subgroup of patients, the change of recurrence mode, the optimal dose of drug, the increase of hypoxia, the enhancement of invasiveness and so on. Therefore, it is necessary to carry out more samples and higher quality large-scale research in the future.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049602
Author(s):  
Tigest Shifraw ◽  
Katarina Selling ◽  
Alemayehu Worku ◽  
Hanna Yemane Berhane ◽  
Eva-Charlotte Ekström ◽  
...  

ObjectivesThe present study evaluates body circumferences as a nutrition screening tool for women of reproductive age with children less than 5 years of age to improve the detection of overweight and obesity in a community setting.DesignThis study draws data from a community-based cross-sectional study conducted between July–August 2017 and January–February 2018 to account for seasonality in Addis Ababa, Ethiopia.SettingOne hundred and sixteen districts were included in Addis Ababa, Ethiopia.ParticipantsA total of 4914 women of reproductive age with children less than 5 years of age were participated in this study.Primary and secondary outcome measuresPrimary outcome measures included anthropometric indices. There were no secondary outcomes.ResultsThe optimal cut-off points to identify overweight women of reproductive age were >87.5 cm for waist circumference (WC), >31.7 cm for neck circumference (NC) and >28.0 cm for mid-upper arm circumference (MUAC) based on the highest corresponding Youden index. The area under the receiver operating characteristics curve was 0.92 (95% CI: 0.91 to 0.93) for WC, 0.83 (95% CI: 0.82 to 0.84) for NC and 0.91 (95% CI: 0.89 to 0.92) for MUAC.ConclusionsOur result shows that WC and MUAC are alternative tools to body mass index. Both WC and MUAC are effective in identifying overweight women. We recommend using MUAC in large-scale population-based assessments to identify overweight and obesity in low-income settings as it is logistically simpler and operationally feasible.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zheng Ying ◽  
Casagrande Maria ◽  
Dimopoulos Spyridon ◽  
Bartz-Schmidt Karl-Ulrich ◽  
Spitzer Matin Stephan ◽  
...  

Abstract Background To evaluate the rate, risk factors, functional outcome and prognosis in eyes with retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy. Methods Electronic patient files from 2009 until 2018 were screened for the presence of an endophthalmitis. Included were 116 eyes of 116 patients. This population was evaluated for the rate of retinal detachment after 23G Pars Plana Vitrectomy for endophthalmitis following cataract surgery or intravitreal injection. The main outcome measures were retinal detachment and visual acuity. Results The reasons for endophthalmitis were previous cataract surgery in 78 patients and following intravitreal injection in 38 patients. The first clinical evidence of endophthalmitis was present in median 5 days after the triggering intervention. Twenty-five eyes (21.55%) developed a retinal detachment an average of 25 days after endophthalmitis. RD is significantly associated with preoperative visual acuity (p = 0.001). Conclusions We emphasize the prognostic role of preoperative visual acuity in RD development of the endophthalmitis treated with 23G Pars Plana Vitrectomy.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055169
Author(s):  
Pritimoy Das ◽  
Zubair Akhtar ◽  
Syeda Mah-E-Muneer ◽  
Md Ariful Islam ◽  
Mohammed Ziaur Rahman ◽  
...  

ObjectivesTo establish a hospital-based platform to explore the epidemiological and clinical characteristics of patients screened for COVID-19.DesignHospital-based surveillance.SettingThis study was conducted in four selected hospitals in Bangladesh during 10 June–31 August 2020.ParticipantsIn total, 2345 patients of all age (68% male) attending the outpatient and inpatient departments of surveillance hospitals with any one or more of the following symptoms within last 7 days: fever, cough, sore throat and respiratory distress.Outcome measuresThe outcome measures were COVID-19 positivity and mortality rate among enrolled patients. Pearson’s χ2 test was used to compare the categorical variables (sign/symptoms, comorbidities, admission status and COVID-19 test results). Regression analysis was performed to determine the association between potential risk factors and death.ResultsCOVID-19 was detected among 922 (39%) enrolled patients. It was more common in outpatients with a peak positivity in second week of July (112, 54%). The median age of the confirmed COVID-19 cases was 38 years (IQR: 30–50), 654 (71%) were male and 83 (9%) were healthcare workers. Cough (615, 67%) was the most common symptom, followed by fever (493, 53%). Patients with diabetes were more likely to get COVID-19 than patients without diabetes (48% vs 38%; OR: 1.5; 95% CI: 1.2 to 1.9). The death rate among COVID-19 positive was 2.3%, n=21. Death was associated with age ≥60 years (adjusted OR (AOR): 13.9; 95% CI: 5.5 to 34), shortness of breath (AOR: 9.7; 95% CI: 3.0 to 30), comorbidity (AOR: 4.8; 95% CI: 1.1 to 21.7), smoking history (AOR: 2.2, 95% CI: 0.7 to 7.1), attending the hospital in <2 days of symptom onset due to critical illness (AOR: 4.7; 95% CI: 1.2 to 17.8) and hospital admission (AOR: 3.4; 95% CI: 1.2 to 9.8).ConclusionsCOVID-19 positivity was observed in more than one-third of patients with suspected COVID-19 attending selected hospitals. While managing such patients, the risk factors identified for higher death rates should be considered.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055864
Author(s):  
Jeremy Fabes ◽  
Gareth Ambler ◽  
Bina Shah ◽  
Norman R Williams ◽  
Daniel Martin ◽  
...  

IntroductionLiver transplantation is a complex operation that can provide significant improvements in quality of life and survival to the recipients. However, serious complications are common and include major haemorrhage, hypotension and renal failure. Blood transfusion and the development of acute kidney injury lead to both short-term and long-term poor patient outcomes, including an increased risk of death, graft failure, length of stay and reduced quality of life. Octreotide may reduce the incidence of renal dysfunction, perioperative haemorrhage and enhance intraoperative blood pressure. However, octreotide does have risks, including resistant bradycardia, hyperglycaemia and hypoglycaemia and QT prolongation. Hence, a randomised controlled trial of octreotide during liver transplantation is needed to determine the cost-efficacy and safety of its use; this study represents a feasibility study prior to this trial.Methods and analysisWe describe a multicentre, double-blind, randomised, placebo-controlled feasibility study of continuous infusion of octreotide during liver transplantation surgery. We will recruit 30 adult patients at two liver transplant centres. A blinded infusion during surgery will be administered in a 2:1 ratio of octreotide:placebo. The primary outcomes will determine the feasibility of this study design. These include the recruitment ratio, correct administration of blinded study intervention, adverse event rates, patient and clinician enrolment refusal and completion of data collection. Secondary outcome measures of efficacy and safety will help shape future trials by assessing potential primary outcome measures and monitoring safety end points. No formal statistical tests are planned. This manuscript represents study protocol number 1.3, dated 2 June 2021.Ethics and disseminationThis study has received Research Ethics Committee approval. The main study outcomes will be submitted to an open-access journal.Trial sponsorThe Joint Research Office, University College London, UK.Neither the sponsor nor the funder have any role in study design, collection, management, analysis and interpretation of data, writing of the study report or the decision to submit the report for publication.Trial registrationThe study is registered with ClinicalTrials.gov (NCT04941911) with recruitment due to start in August 2021 with anticipated completion in July 2022.Clinical trials unitSurgical and Interventional Group, Division of Surgery & Interventional Science, University College London.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e046962
Author(s):  
Amanuel Tesfay Gebremedhin ◽  
Gizachew Assefa Tessema ◽  
Annette K Regan ◽  
Gavin F Pereira

ObjectiveTo examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.Design and settingPopulation-based longitudinally linked cohort study in Western Australia (WA).ParticipantsMothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015.Outcome measuresWe estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference.ResultsRisks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM.ConclusionsThe associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.


2021 ◽  
Author(s):  
Nanina Anderegg ◽  
Radoslaw Panczak ◽  
Matthias Egger ◽  
Nicola Low ◽  
Julien Riou

Objectives: To investigate mortality among people hospitalised with covid-19 in Switzerland according to epidemic wave, age, sex, comorbid conditions and intensive care unit (ICU) occupancy. Design: Population-based, national study.Setting: Mandatory surveillance reports from all hospitals in Switzerland. Participants: All 22,648 people who tested positive for SARS-CoV-2 infection and were hospitalised between February 24, 2020 and March 01, 2021 in Switzerland with complete information about age, sex, and comorbidities. Main outcome measures: Survival after positive SARS-CoV-2 test among people hospitalised with covid-19 by epidemic wave, age, sex, comorbid conditions and ICU occupancy, expressed as adjusted hazard ratios (aHR) of death and probability of survival over time and at 40 days, all with 95% credible intervals (CrI). Results: Of 22,648 people hospitalised with covid-19, 4,785 (21.1%) died. Bayesian survival models adjusted for age, sex, and the presence of comorbidity showed that survival was lower during the first epidemic wave than the second (standardised predicted survival probability at 40 days 76.1% versus 80.5%; aHR of death 1.38, 95% CrI 1.28 to 1.48). During the second epidemic wave, occupancy among all available ICU beds (certified beds and add-on beds) in Switzerland varied between 51.7% and 78.8%. Modelling the association between survival and ICU occupancy with restricted cubic splines indicated stable survival when ICU occupancy was below 70%, but worse survival when ICU occupancy exceeded 70%. This threshold of 70% occupancy among total available ICU beds corresponded to around 85% occupancy among certified beds. Survival was decreased for men, older people, and patients with comorbid conditions. Comorbid conditions reduced survival more in younger people than in older people. As single comorbid condition, hypertension was not associated with poorer survival, but appeared to increase the risk of death in combination with a cardiovascular disease. Conclusion: Survival after hospitalisation with covid-19 has improved over time, consistent with improved management of severe covid-19. The decreased survival starting at approximately 70% ICU occupancy in Switzerland supports the need to introduce measures for prevention and control of SARS-CoV-2 transmission in the population far before ICUs are full.


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