Purpose: Patients with severe asthma (SA) are at an increased risk of asthma-related hospitalizations and exacerbations. Despite concerns that COVID-19 circulation would increase exacerbations of SA, ...anecdotal reports suggest that social distancing and exposure avoidance may have led to reduced exacerbations. Patients and methods: CHRONICLE is an ongoing noninterventional observational study of 3100 subspecialist-treated patients with SA. Eligible adults (> 18 years of age) have (1) current use of monoclonal antibody (ie, biologic) therapy for SA, (2) use of maintenance systemic corticosteroids (mSCS) or other systemic immunosuppressants for > 50% of the prior 12 months for SA, or (3) persistently uncontrolled asthma while treated with high-dosage inhaled corticosteroids with additional controllers. For enrolled patients, electronic medical records were reviewed to record all exacerbations and asthma-related hospitalizations. Descriptive analyses were conducted of the monthly incidence of exacerbations, exacerbation-related visits to the emergency department (ED), and asthma hospitalizations from July 2018 through July 2021. Results: Exacerbations, exacerbation-related ED visits, and hospitalizations decreased since April 2020. Exacerbations in 2020 were 20% to 52% lower in April through August relative to the same months in 2019. Exacerbations remained lower than the prior year through May 2021. Similar results were observed by United States (US) census region, with an earlier decrease in exacerbation rates in the western US versus other regions. Across all months, exacerbation rates were lower among biologic recipients. Conclusion: In a clinical cohort of subspecialist-treated patients with SA, there was a meaningful reduction in exacerbations, exacerbation-related ED visits, and asthma hospitalizations following COVID-19-related stay-at-home orders and social distancing recommendations. Reasons for these reductions are likely multifactorial, including reduced viral infections due to less social contact and altered patient behavior. Keywords: management/control, healthcare resource use
Abstract
Objective
Determine the correlation between post–sympathetic block temperature change and immediate- and intermediate-term pain relief.
Design
Retrospective analysis.
Setting
Academic ...setting.
Subjects
Seventy-nine patients with complex regional pain syndrome who underwent sympathetic block.
Methods
Pre- and post-block temperatures in the affected extremity and pain scores immediately (based on 6-hour pain diary) after the block and at the intermediate-term 4- to 8-week follow-up were recorded. Post-block pain reductions of 30–49% and ≥50% were designated as partially sympathetically maintained pain and sympathetically maintained pain, respectively. A decrease in pain score ≥2 points lasting ≥4 weeks was considered a positive intermediate-term outcome for sympathetic block.
Results
A weak correlation was found between immediate-term pain relief and the extent of temperature rise for the cohort (R = 0.192, P = 0.043). Greater immediate-term pain reduction was reported among patients who experienced a temperature increase ≥7.5°C (mean 4.1; 95% confidence interval CI: 3.33 to 4.76) than among those who experienced a temperature increase <2°C (2.3; 95% CI: 1.36 to 3.31) or ≥2°C to <7.5°C (2.9; 95% CI: 1.8 to 3.9; P = 0.036). The correlations between temperature increase and intermediate-term pain score reduction at 4–8 weeks (R = 0.052, P = 0.329) and between immediate- and intermediate-term pain relief (R = 0.139, P = 0.119) were not statistically significant.
Conclusions
A weak correlation was found for those who experienced greater temperature increases after the block to also experience greater immediate pain relief. Higher temperature increase cutoffs than are typically used might be necessary to determine whether a patient with complex regional pain syndrome has sympathetically maintained pain.
Invasive medical devices are used in treating millions of patients each day. Bacterial adherence to their surface is an early step in biofilm formation that may lead to infection, health ...complications, longer hospital stays, and death. Prevention of bacterial adherence and biofilm development continues to be a major healthcare challenge. Accordingly, there is a pressing need to improve the anti-microbial properties of medical devices.
Polydimethylsiloxane (PDMS) was doped with halloysite nanotubes (HNTs), and the PDMS-HNT composite surfaces were coated with PDMS-b-polyethylene oxide (PEO) and antibacterials. The composite material properties were examined using SEM, energy dispersive spectroscopy, water contact angle measurements, tensile testing, UV-Vis spectroscopy, and thermal gravimetric analysis. The antibacterial potential of the PDMS-HNT composites was compared to commercial urinary catheters using cultures of
and
. Fibrinogen adsorption studies were also performed on the PDMS-HNT-PEO composites.
HNT addition increased drug load during solvent swelling without reducing material strength. The hydrophilic properties provided by PEO were maintained after HNT addition, and the composites displayed protein-repelling properties. Additionally, composites showed superiority over commercial catheters at inhibiting bacterial growth.
PDMS-HNT composites showed superiority regarding their efficacy at inhibiting bacterial growth, in comparison to commercial antibacterial catheters. Our data suggest that PDMS-HNT composites have potential as a coating material for anti-bacterial invasive devices and in the prevention of institutional-acquired infections.
The reference sequence for each human chromosome provides the framework for understanding genome function, variation and evolution. Here we report the finished sequence and biological annotation of ...human chromosome 1. Chromosome 1 is gene-dense, with 3,141 genes and 991 pseudogenes, and many coding sequences overlap. Rearrangements and mutations of chromosome 1 are prevalent in cancer and many other diseases. Patterns of sequence variation reveal signals of recent selection in specific genes that may contribute to human fitness, and also in regions where no function is evident. Fine-scale recombination occurs in hotspots of varying intensity along the sequence, and is enriched near genes. These and other studies of human biology and disease encoded within chromosome 1 are made possible with the highly accurate annotated sequence, as part of the completed set of chromosome sequences that comprise the reference human genome.
Objective The treatment of complex anorectal and rectovaginal fistulae remains a difficult problem. The options are fistulotomy, setons, fibrin glue and a variety of flap procedures. Recently, there ...have been several reports of a new plug; the Surgisis® AFP™ plug. Reports from various centres do not give consistent results. The aim of this study was to assess the efficacy of the Surgisis® AFP™ fistula plug in a wide spectrum of patients with anorectal, rectovaginal and pouch vaginal fistulae.
Method Between March 2006 and September 2007, patients with a variety of anal fistulae were selected for fistula plug insertion in the coloproctology units at Leeds, UK, and Aarhus, Denmark. Demographic and fistulae details were obtained. Postoperatively, all patients had a course of oral antibiotics.
Results Forty‐three patients with a median age of 45 (range 18–65) years underwent a total of 45 procedures. Seventy‐five per cent (n = 32) had a fistula secondary to cryptoglandular abscess. Median follow up was 47 (range 12–77) weeks. The success rate for complete healing was 44%. Dislodgement caused failure on 10 (22%) occasions.
Conclusion Our study shows a moderate success rate for treatment with fistula plugs. The complex nature of the fistulae selected may be the reason for the low success rate.
Chromosome 9 is highly structurally polymorphic. It contains the largest autosomal block of heterochromatin, which is heteromorphic in 6-8% of humans, whereas pericentric inversions occur in more ...than 1% of the population. The finished euchromatic sequence of chromosome 9 comprises 109,044,351 base pairs and represents >99.6% of the region. Analysis of the sequence reveals many intra- and interchromosomal duplications, including segmental duplications adjacent to both the centromere and the large heterochromatic block. We have annotated 1,149 genes, including genes implicated in male-to-female sex reversal, cancer and neurodegenerative disease, and 426 pseudogenes. The chromosome contains the largest interferon gene cluster in the human genome. There is also a region of exceptionally high gene and G + C content including genes paralogous to those in the major histocompatibility complex. We have also detected recently duplicated genes that exhibit different rates of sequence divergence, presumably reflecting natural selection.
We compared the diagnostic performance and correlation between salivary, serum and capillary blood glucose of diabetes and non-diabetes patients. Early detection of diabetes mellitus (DM) contributes ...to the prevention of complications and management.
This case-control study was conducted among a total of 138 participants comprising 79 newly diagnosed diabetes patients (cases) and 59 non-diabetes patients (controls). Fasting salivary glucose (FSLG), fasting serum glucose (FSEG) levels and fasting capillary whole blood glucose (FCWBG) level were assayed for each participant.
The mean FSLG, FSEG and FCWBG levels were significantly higher among the cases compared to controls (p < 0.0001). There was a significant mean difference between the levels of FSLG vs. FSEG (p < 0.0001) and FSLG vs. FCWBG (p < 0.0001) but not levels of FSEG vs. FCWBG (p > 0.05) in both cases and controls. A positive correlation was observed between FSLG and FSEG (r = 0.89; p < 0.0001) and FCWBG (r = 0.87; p < 0.0001). At the cut-off value >6.8 mmol/l for FSEG, a sensitivity of 99%, specificity of 100.0% and area under the curve (AUC) of 98.8% was observed for predicting DM while a sensitivity of 80%, specificity of 95% and AUC of 91.0% was observed for FSLG at a cut-off value >0.5 mmol/l. At the cut-off value >6.9 mmol/l for FCWBG, a sensitivity of 100.0%, specificity of 100.0% and AUC of 100.0% was observed for predicting DM.
Fasting salivary glucose (FSLG) levels increased with increasing blood glucose levels. However, it does not generate enough diagnostic and predictive accuracy compared to capillary whole blood glucose which less invasive.
Chromosome 13 is the largest acrocentric human chromosome. It carries genes involved in cancer including the breast cancer type 2 (BRCA2) and retinoblastoma (RB1) genes, is frequently rearranged in ...B-cell chronic lymphocytic leukaemia, and contains the DAOA locus associated with bipolar disorder and schizophrenia. We describe completion and analysis of 95.5 megabases (Mb) of sequence from chromosome 13, which contains 633 genes and 296 pseudogenes. We estimate that more than 95.4% of the protein-coding genes of this chromosome have been identified, on the basis of comparison with other vertebrate genome sequences. Additionally, 105 putative non-coding RNA genes were found. Chromosome 13 has one of the lowest gene densities (6.5 genes per Mb) among human chromosomes, and contains a central region of 38 Mb where the gene density drops to only 3.1 genes per Mb.
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