Exhaled Mycobacterium tuberculosis predicts incident infection in household contacts

Background Halting transmission of Mycobacterium tuberculosis (Mtb) by identifying infectious individuals early is key to eradicating Tuberculosis (TB). Here we evaluate face mask sampling as a tool for stratifying infection risk in household contacts of pulmonary TB (pTB). Methods Forty-six sputum positive pTB patients in The Gambia (Aug 2016-Nov 2017) consented to mask sampling prior to commencing treatment. Incident Mtb infection was defined in their 181 household contacts as QuantiFERON (QFT) conversion or an increase in Interferon-ƴ release of ≥ 1IU/ml, 6 months after index diagnosis. Multilevel mixed-effects logistical regression analysis with cluster adjustment by household was used to identify predictors of incident infection. Findings Mtb was detected in 91% of pTB mask samples with high variation in IS6110 copies (5.3 x102 to 1.2 x107). A high mask Mtb level (≥20,000 IS6110 copies) was observed in 45% of cases and independently associated with increased likelihood of incident Mtb infection in contacts (AOR (95%CI) 3.20 (1.26 - 8.12), p=0.01), compared with cases having low/negative mask Mtb levels. Mask Mtb level was a better predictor of incident Mtb infection than sputum bacillary load, chest radiographic characteristics or sleeping proximity. Interpretation Mask sampling offers a highly sensitive and non-invasive tool to support both diagnosis of pTB and stratification of individuals who are most infectious. Our findings have the potential to revolutionise contact screening strategies and outbreak management in high TB burden settings and is of urgent public health importance.

Plasma fibrinogen, d-dimer, and fibrin degradation product as biomarkers of rheumatoid arthritis

This study aimed to assess the association of coagulation-related indicators such as plasma fibrinogen (FIB), d-dimer, and fibrin degradation product (FDP) in rheumatoid arthritis (RA) with the disease activity. Data from 105 RA patients and 102 age- and gender-matched healthy controls were collected in the retrospective study. Disease activity score in 28 joints based on C-reactive protein (DAS28-CRP) was used to divide RA patients into low activity group (DAS28-CRP ≤ 2.7) and active group (DAS28-CRP > 2.7). Receiver operating characteristic (ROC) curve was applied to determine area under the curve (AUC). The association between plasma FIB, d-dimer, and FDP and DAS28-CRP was evaluated by spearman correlation. Logistical regression analysis was used to identify the independent variables associated with RA disease activity. RA patients showed higher levels of plasma FIB, d-dimer, and FDP than the controls (P < 0.01). Plasma FIB, d-dimer, and FDP were also increased in active groups of RA patients than those in inactive groups (P < 0.001). ROC curve analyses revealed that the AUC of d-dimer was higher than erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF), and that of FDP was higher than RF in RA patients. In addition, the optimal cut-off value of plasma FIB, d-dimer, and FDP for RA diagnosis was 286 mg/dL, 470 μg/L, and 1.45 mg/L, respectively. Spearman analysis showed that plasma FIB, d-dimer, and FDP were positively related with DAS28-CRP (P < 0.001) in RA patients. Logistical regression analysis showed that d-dimer (odds ratio 2.862, 95% confidence interval 1.851–5.426, P < 0.001) was an independent variable associated with RA disease activity. FIB, d-dimer, and FDP were increased in RA patients and positively correlated with the disease activity of RA. d-dimer may act as a novel inflammatory indice for indicating disease activity in RA patients.

Prophylactic subcutaneous retention sutures in the prevention of superficial wound separation of midline laparotomy

ObjectivesThis prospective study aimed to determine the effectiveness of prophylactic subcutaneous retention sutures in the prevention of superficial wound separation in women with a confirmed or suspected cancer who had gynecological surgery by midline laparotomy.MethodsThis was a non-randomized, controlled intervention study including patients who underwent cancer surgery between May 2018 and August 2019. Patients who underwent midline laparotomy with confirmed or suspected cancer were included and patients who had an early post-operative complication or who underwent surgery again before the removal of stitches were excluded. The independent variables that might predict the superficial wound site dehiscence and prolongation of the hospitalization period were analyzed using logistical regression analysis.ResultsA total of 208 patients were included in the study. Age, presence of comorbid diseases, low pre-operative hemoglobin, low pre-operative albumin, higher weight, higher body mass index (BMI), pre- and post-operative blood transfusion, and absence of retention sutures were associated with higher risk of superficial wound separation. Low pre-operative albumin, weight, and BMI were associated with prolonged length of hospital stay. In a multivariate analysis, BMI (OR: 1.12; 95% CI: 1.09 to 1.28, p<0.001) and retention sutures (OR: 0.31; 95% CI: 0.11 to 0.83, p=0.019) retained an independent association with superficial wound separation. In addition, BMI (OR: 1.11; 95% CI: 1.03 to 1.25, p=0.010) and intra-operative complications (OR: 4.10; 95% CI: 1.08 to 15.60, p=0.038) were independent predictors increasing the length of hospital stay, and use of retention sutures (OR: 0.19; 95% CI: 0.05 to 0.66, p=0.009) was an independent predictor decreasing the length of hospital stay.ConclusionsProphylactic subcutaneous retention sutures reduced superficial wound separation and shortened hospital stay. Prophylactic subcutaneous retention sutures may be considered in patients who undergo gynecological surgery using a midline laparotomy.

Point of care ankle pulse waveform: A biomarker for abdominal aortic aneurysm?

Objective To explore the potential relationship between the presence of abdominal aortic aneurysm and point of care ankle brachial index acquired posterior tibial artery Doppler waveform to inform on a potential novel biomarker of abdominal aortic aneurysm presence. Methods Abdominal aortic aneurysm presence and posterior tibial artery waveform acquired at time of routine point of care ankle brachial index were determined in 182 patients from an abdominal aortic aneurysm evaluation vascular outpatient clinic. Multivariate technical random forest analysis and logistical regression analysis assessed the outcome of abdominal aortic aneurysm presence and included the independent variables of monophasic initial posterior tibial artery waveform and known abdominal aortic aneurysm risk factors. Results Technical random forest analysis produced a model with an accuracy of 0.59. Initial waveform phase was the most important variable included in the model. Logistical regression analysis revealed a statistically significant negative association between initial monophasic posterior tibial artery waveform and abdominal aortic aneurysm presence in patients with ankle brachial index > 0.9. Leave one out cross validation analysis produced a bias-corrected prediction error value of 0.22. Conclusion No robust association between abdominal aortic aneurysm and point of care ankle brachial index acquired posterior tibial artery waveform was found, suggesting that monophasic posterior tibial artery waveform alone may not be a biomarker of abdominal aortic aneurysm presence.

The safety profile and angioarchitectural changes after acute targeted embolization of ruptured arteriovenous malformations

OBJECTIVE The aim of this study was to 1) compare the safety and efficacy of acute targeted embolization of angiographic weak points in ruptured brain arteriovenous malformations (bAVMs) versus delayed treatment, and 2) explore the angioarchitectural changes that follow this intervention. METHODS The authors conducted a retrospective analysis of a prospectively acquired database of ruptured bAVMs. Three hundred sixteen patients with ruptured bAVMs who presented to the hospital within 48 hours of ictus were included in the analysis. The first analysis compared clinical and functional outcomes of acutely embolized patients to those with delayed management paradigms. The second analysis compared these outcomes of patients with acute embolization to those with angiographic targets who did not undergo acute embolization. Finally, a subset of 20 patients with immediate postembolization angiograms and follow-up angiograms within 6 weeks of treatment were studied to determine the angioarchitectural changes after acute targeted embolization. Kaplan-Meier curves for survival between the groups were devised. Multivariate logistical regression analysis was conducted. RESULTS There were three deaths (0.9%) and an overall rerupture rate of 4.8% per year. There was no statistical difference in demographic variables, mortality, and rerupture rate between patients with acute embolization and those with delayed management. Patients with acute embolization were more likely to present functionally worse (46.9% vs 69.8%, modified Rankin Scale score 0–2, p = 0.018) and to require an adjuvant therapy (71.9% vs 26.4%, p < 0.001). When comparing acutely embolized patients to those nonacutely embolized angiographic targets, there was a significant protective effect of acute targeted therapy on rerupture rate (annual risk 1.2% vs 4.3%, p = 0.025) and no difference in treatment complications. Differences in the survival curves for rerupture were statistically significant. Multivariate analyses significantly predicted lower rerupture in acute targeted treatment and higher rerupture in those with associated aneurysms, deep venous anatomy, and higher Spetzler-Martin grade. All patients with acute embolization experienced complete obliteration of the angiographic weak point with various degrees of resolution of the nidus; however, some had spontaneous recurrence of their bAVM, while others had spontaneous resolution over time. No patients developed new angiographic weak points. CONCLUSIONS This study demonstrates that acute targeted embolization of angiographic weak points, particularly aneurysms, is technically safe and protective in the early phase of recovery from ruptured bAVMs. Serial follow-up imaging is necessary to monitor the evolution of the nidus after targeted and definitive treatments. Larger prospective studies are needed to validate these findings.

Predictors of inadequate bowel preparation using two liters of polyethylene glycol for colonoscopy

Background: Inadequate bowel preparation can result in missed pathological lesions and cancellation of procedures thereby increasing the cost and delay in the diagnosis. Objectives: Thes aim of the study was to identify the potential predictors of inadequate bowel preparation using 2 liters of polyethylene glycol solution. Methodology: A prospective study was done, which included 138 consecutive patients who underwent colonoscopy over a period of 6 months. Patient’s demographics, medical history, and preparation quality were collected and compared. Factors associated with inadequate bowel preparation were identified by univariate statistics and multivariate logistical regression analysis. Results: Out of 138 colonoscopy procedure, 119 (86.2%) preparations were adequate and 19 (13.8%) were inadequate. The mean age of the patient was 52.62 (SD ±10.51) years. Out of which, 82 (59.4%) were male and 56 (40.6%) were female. In the multivariate regression analysis, constipation [adjusted OR 8.55, 95% CI 1.79-41.67] and non-compliance [adjusted OR 58.82, 95% CI 5.99-500] were independently associated with inadequate bowel preparation. Conclusion: Constipation, non-compliance, overweight, neurological disorders like stroke, dementia and age >60 years were associated with inadequate bowel preparation. Early identification of patients with a high risk of inadequate preparation can be salvaged with change in bowel cleaning strategy.

Relationship Between Periosteal Reaction and Medial Compartment Knee Osteoarthritis in Observation of Chinese Patients: A Retrospective Single-Centre Comparative Study

Background: The purpose of this study to evaluate the potential relationship between the periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the related risk factors for the development of periosteal reaction associated with medial compartment KOA.Methods: From January 2019 to December 2019, a total of 476 consecutive patients with medial compartment KOA were included and assessed in this retrospective comparative study. They were divided into two groups: periosteal reaction group and non-periosteal reaction group. Radiological parameters was measured for malalignment of the lower extremities in coronal plane. Intra-observer and inter-observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses was conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate binary logistical regression analysis were performed to determine the independent risk factors of radiographic parameters for periosteal reaction.Results: A total of 363 patients (726 knees) were selected for the study, including 91 males and 272 females, with an average age of 57.9±12.8 years (range, 18-82 years). The overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, the incidence of periosteal reaction significantly increased with age and K-L grade progressed (P＜0.05). Multivariate logistical regression analysis found that HKA and JICA were significantly correlated with the development of periosteal reaction adjacent to the lateral of proximal tibia diaphysis in medial compartment KOA (P＜0.05).Conclusions: Our observation of the reaction of periosteum may be an anatomical adaptation for medial compartment KOA. Patients with lower HKA and higher JICA are more likely to developing periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis.

A Comparative Analysis between Global University Rankings and Environmental Sustainability of Universities

Global University Rankings (GURs) intend to measure the performance of universities worldwide. Other rankings have recently appeared that evaluate the creation of environmental policies in universities, e.g., the Universitas Indonesia (UI) GreenMetric. This work aims to analyze the interaction between the Top 500 of such rankings by considering the geographical location of universities and their typologies. A descriptive analysis and a statistical logistical regression analysis were carried out. The former demonstrated that European and North American universities predominated the Top 500 of GURs, while Asian universities did so in the Top 500 of the UI GreenMetric ranking, followed by European universities. Older universities predominated the Top 500 of GURs, while younger ones did so in the Top 500 of the UI GreenMetric ranking. The second analysis demonstrated that although Latin American universities were barely present in the Top 500 of GURs, the probability of them appearing in the Top 500 of the UI GreenMetric ranking was 5-fold. We conclude that a low association exists between universities’ academic performance and their commitment to the natural environment in the heart of their institutions. It would be advisable for GURs to include environmental indicators to promote sustainability at universities and to contribute to climate change.

Clinical Outcomes and Factors of Single Attempt of Stent Retrieval during Endovascular Thrombectomy for Acute Ischemic Stroke

Backgrounds: Single attempt of stent retrieval during endovascular thrombectomy (EVT) seems to be associated with favorable clinical outcomes of patients with acute ischemic stroke (AIS), but the relationship between single attempt and clinical outcomes or complications have not been characterized. In addition, the factors related to single retrieval attempts during EVT are undefined. Here, we investigated the relationship between single attempt of stent retrieval and the clinical outcomes or complications after EVT, and further investigated the factors associated with single attempt of stent retrieval in AIS patients. Methods: This study enrolled consecutive patients with AIS treated by EVT with second-generation stent retriever devices from April 2016 to April 2019. Attempts of EVT were classified as single or multiple attempts of stent retrieval after filtrating all enrolled patients based on inclusion and exclusion criteria. We analyzed the clinical outcomes and complications between single attempt of stent retrieval and multiple attempts of stent retrieval, and the factors independently associated with a single attempt were identified through logistical regression analysis. Results: We enrolled 143 patients, including 69 patients with single attempt of stent retrieval and 74 patients with multiple attempts of stent retrieval. More patients with single attempt of stent retrieval reached favorable clinical outcomes ( p =0.016; adjusted OR [95%CI]: 2.652 [1.204-5.843] ), and patients with single attempts of stent retrieval showed as a lower incidence of symptomatic intracranial hemorrhage (sICH) ( p =0.046; adjusted OR [95%CI]: 0.192 [0.038-0.973] ). Diabetes mellitus ( p =0.026; adjusted OR [95%CI]: 2.871 [1.137-7.249] ) was independently associated with single attempt of EVT with stent retrieval. Conclusions: Single attempt of stent retrieval during EVT can decrease incidence of sICH and improve favorable clinical outcomes of patients with AIS. Those with diabetes mellitus may be more prone to single attempt of stent retrieval during EVT .

Risk factors and incidence of poor bowel preparation in elderly patients: Prospective study

Aim: The aim of this study was to identify the incidence of and the risk factors for poor bowel preparation in elderly patients. Patients and methods: We enrolled 240 patients over 60 years of age, hospitalized in the Clinic of Gastroenterology, Kaspela University Hospital between October 2016 and May 2017 and scheduled them for colonoscopy. We recorded patients’ demographics data, clinical characteristics and the rate of bowel preparation. Factors associated with poor bowel preparation were identified by multivariate logistical regression analysis. Results: The rate of poor bowel preparation was 33.6%. Factors associated with poor bowel preparation were a history of abdominal surgery (OR, 2.617, CI, 1.324-5.174), chronic constipation (OR, 3.307; CI, 1.551-7.054), non-compliance with dietary instructions (OR, 2.239, CI, 1.122-4.471), noncompliance with polyethylene glycol (PEG) dosage (OR, 4.576, CI, 1.855-11.287), walking less than 30 min during preparation (OR, 2.474; CI, 1.261-4.855), interval between PEG ingestion and the onset of bowel activity (OR, 1.025, CI, 1.010-1.040), the latest stool that was not clear and watery (OR, 4.191; CI, 1.529-11.485). Conclusions: Elderly patients tend to have suboptimal preparation for colonoscopy. Walking less than 30 min. during the PEG ingestion period may be a surrogate for bowel preparation failure. Future studies should identify patients at risk for poor bowel preparation. Methods and interventions should be developed to improve outcomes.