COVID-19 infection in patients with intestinal failure: UK experience.

BACKGROUND: The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS: A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION: This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.

Development and validation of measures to evaluate adolescents' knowledge about human papillomavirus (HPV), involvement in HPV vaccine decision-making, self-efficacy to receive the vaccine and fear and anxiety.

OBJECTIVES: We describe the development and validation of measures of human papillomavirus (HPV)/HPV vaccination knowledge, fear/anxiety about vaccination, involvement in HPV vaccine decision-making, and self-efficacy with regard to getting the vaccine, designed to evaluate the efficacy of an intervention to affect these domains (collectively termed the HAVIQ: HPV Adolescent Vaccine Intervention Questionnaire). STUDY DESIGN: Literature search, cognitive interviews and cross-sectional survey. METHODS: A literature search identified existing items that were modified for the present measures. Experts reviewed draft measures for face and content validity. Cognitive interviews with adolescents were also used to assess content validity. Adolescents completed the measures and an internal reliability analysis of each measure was performed. RESULTS: The four experts concurred that the measures had face validity. Cognitive interviews identified items requiring refinement. Content validity was examined with ten experts and was deemed acceptable. There were 1800 adolescents who completed the measures; Cronbach's alpha was >0.6 for three of the four measures. The four final measures are brief, comprising 25 items in total. CONCLUSIONS: The measures are robustly developed and validity-tested. The HAVIQ may be used in research settings to evaluate adolescents' knowledge and experiences of the process of HPV vaccination in a school-based vaccination programme.

Palliative home parenteral nutrition: Clinical service evaluation and identifying potential prognostic factors to assist with patient selection.

BACKGROUND AND AIMS: Home parenteral nutrition (HPN) for palliation has little evidence supporting existing guidance. Patient selection remains challenging. We aimed to evaluate use of palliative HPN in our service against ESPEN guidance, and to identify potential prognostic indicators. METHODS: Palliative care patients commenced on HPN were identified. Medical notes, computer records and HPN database were accessed to identify patient demographics, primary diagnosis and aetiology of intestinal failure, blood test results potentially associated with prognosis (eGFR, albumin, CRP, Hb), presence of ascites, and PN duration. By dichotomising blood results Kaplan-Meier survival plots were derived to identify potential associations with survival. RESULTS: From the HPN database of 111 patients, 20 (18%) were identified as palliative. Six were male (30%), median age (interquartile range (IQR)) 56.4 (51.5-66.8) years. Four patients commenced palliative HPN between 2000 and 2006, while 2007-2013 there were 16. The median number (IQR) of nights on HPN was 85 (19-352). The most common indication was gastro-intestinal obstruction (n = 13, 65%) and short bowel syndrome following palliative surgical resection (n = 4, 20%). Kaplan-Meier survival plots identified worse prognosis on HPN if the presenting albumin was ≤30 g/L p = 0.016. CONCLUSION: The use of HPN in palliative care is increasing. Current patient selection meets with ESPEN guidance with respect to aetiology of intestinal failure and length of survival on PN. We suggest that a low albumin (not a marker of malnutrition) may help to predict those who are likely to survive less long on palliative HPN. A multi-centre prospective study, also examining quality of life would help define improved guidance.

Palliative parenteral nutrition use in patients with intestinal failure as a consequence of advanced pseudomyxoma peritonei: a case series.

Pseudomyxoma peritonei (PMP) is a rare condition complicated by intra-abdominal spread that can cause multilevel gastrointestinal (GI) obstruction. Parenteral nutrition (PN) use in the context of palliative care and malignancy remains controversial. We describe the use of palliative PN in three patients with progressive PMP causing multilevel GI obstruction and intestinal failure. All patients received > 90 days of PN. PN was safe in this cohort of patients. However, patient selection and the timing of intervention are important factors when considering the initiation of PN.

Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey.

INTRODUCTION: Post-partum vaccination of new mothers is currently recommended in Australia to reduce pertussis infection in infants. Internationally, vaccination recommendations now include pregnant women in some countries. Understanding the awareness of pertussis vaccination recommendations among pregnant women, and their willingness to have the vaccine while pregnant is important for informing vaccine program implementation. OBJECTIVE: To determine awareness and intentions toward current recommendations for post-partum pertussis vaccination among Australian pregnant women, and their willingness to accept pertussis vaccine during pregnancy, should it be recommended in Australia in the future. DESIGN: Quantitative self-administered survey, using a non-random stratified sampling plan based on representative proportions by age, parity and region of residence. PARTICIPANTS AND SETTING: Pregnant women receiving antenatal care through three large, demographically diverse referral hospitals in metropolitan, urban and rural New South Wales, Australia. RESULTS: The response rate was 815/939 (87%). Most women (80%) reported willingness to have the pertussis vaccine during pregnancy, should it be recommended. Thirty four per cent of women intended to receive a pertussis vaccine post-partum, 17% had received it previously, while 45% had never heard of pertussis vaccine, had not thought about it, or were undecided about having it. Compared with those who had not received a recommendation to have the vaccine post-partum, women who had received a recommendation were 7 times more likely (95% CI 4-14) to report intention to have the vaccine. CONCLUSIONS: Health care provider recommendation is paramount to raising awareness of pertussis vaccination recommendations among pregnant women. Women's willingness to have the vaccine while pregnant is encouraging, and indicates the potential for high pertussis vaccine coverage among pregnant women, should it be recommended in Australia.

Subjects with prostate cancer are less likely to develop esophageal cancer: analysis of SEER 9 registries database.

Esophageal adenocarcinoma (EAC) is five times more common among men. EAC tissue exhibits an increased concentration of androgen receptors. We previously reported lower EAC incidence following prostate cancer (PC), suggesting androgen deprivation therapy may reduce EAC incidence, but were unable to demonstrate reducing incidence of EAC with time (latency effect) that would support a cumulative effect of anti-androgen treatment.The Survival Epidemiology and End Results (SEER9) dataset from 1977­2004 was therefore examined to identify subjects with a first malignant primary of PC.Subjects were followed until second primary cancer diagnosis,death, or time period end. Age- and period-adjusted standardized incidence ratios (SIR) were calculated as an estimate of relative risk of an esophageal second malignant primary. Between 1977 and 2004, 343,538 subjects (following exclusion criteria) developed PC as a first primary malignant tumor, providing 2,014,337 years of follow-up.Subsequently 604 esophageal cancers developed, with 763 expected. The incidence of EAC fell following PC [SIR0.83 (95 % CI 0.74­0.93)] with a latency effect identified with SIR 1.1 3 months to 1 year post-PC, SIR 0.85 1­5 years post-PC, and SIR 0.75 greater than five years post-PC. The incidence of esophageal squamous cell carcinoma (ESCC) after PC was also reduced [SIR, 0.79 (0.69-0.89)],with evidence of a latency effect also seen. There is a reduced risk of developing esophageal cancer, both EAC and ESCC, following PC. Androgen deprivation therapy may contribute, but changes in lifestyle following PC diagnosis and decrease in ESCC incidence are also plausible explanations.

A natural history of cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia associated with clavicle hypoplasia and dental abnormalities. The condition is caused by mutations in the CBFA1 gene, a transcription factor that activates osteoblast differentiation. Clinical characteristics associated with CCD have previously been described in case reports and small case series. This study was undertaken to gain a more complete delineation of clinical complications associated with CCD. The study population was composed of 90 CCD individuals and 56 relative controls ascertained from genetic and dental practices in the United States, Canada, Europe, and Australia. A number of previously unrecognized complications were significantly increased including: genua valga, scoliosis, pes planus, sinus infections, upper respiratory complications, recurrent otitis media, and hearing loss. Primary Cesarean section rate was significantly increased compared to relative controls and the general population rate. Finally, dental abnormalities, including supernumerary teeth, failure of exfoliation of the primary dentition, and malocclusion, are serious and complex problems that require intervention. Clinical recommendations based on the results of this study are included.

Effects of stretch or distention on phenylephrine-induced constriction of human coronary artery bypass grafts.

OBJECTIVE: To determine the effects of grafting saphenous veins into the arterial circulation and to compare the responsiveness of saphenous veins and mammary arteries to vasoconstrictors (phenylephrine or potassium) and a vasodilator (the calcium antagonist isradipine). DESIGN: Prospective, controlled, in vitro study. SETTING: Laboratory facility in a university teaching hospital. PARTICIPANTS: Small excess segments of internal mammary arteries or saphenous veins obtained from patients undergoing coronary artery bypass graft surgery. INTERVENTIONS: Vessel segments were cut into rings to measure isometric tension development in isolated tissue chambers. The law of LaPlace for a cylinder was applied to determine tensions in vitro corresponding with arterial or venous tensions in vivo or distending pressures ex vivo. MEASUREMENTS AND MAIN RESULTS: Stretching saphenous vein rings from venous to arterial tensions reduced maximal phenylephrine-induced constriction but did not alter their dose response to phenylephrine, potassium, or isradipine. At arterial tensions, potassium, but not phenylephrine, was more potent in constricting mammary artery than saphenous vein; isradipine was more potent as a vasodilator of potassium-constricted mammary artery than saphenous vein. Maximal phenylephrine-induced or potassium-induced constriction was no different for either vessel at arterial tensions; however, prior distention of veins to tensions corresponding with pressures of 200 or 300 mmHg significantly (p < 0.01, Dunnett's test) reduced subsequent constriction. CONCLUSION: Phenylephrine may be more likely to constrict native internal mammary arteries than distended autogenous saphenous vein grafts in vivo because high-pressure distention of veins markedly inhibits their vasoreactivity.

Conjunctival flora observed in 70 healthy domestic rabbits (Oryctolagus cuniculus).

Conjunctival swabs were taken from both eyes of 70 healthy domestic rabbits and cultured to determine the microbial population. Bacteria were recovered from 83 per cent of the specimens. DNase-negative Staphylococcus species (57 per cent) were the most commonly recovered organisms followed by Micrococcus species (25 per cent) and Bacillus species (19 per cent). Other organisms isolated included Stomatococcus species (8 per cent), Neisseria species (8 per cent), Pasteurella species (6 per cent), Corynebacterium species (6 per cent), Streptococcus species (6 per cent) and Moraxella species (4 per cent), and other bacteria were isolated less frequently. Statistical analysis showed that there appeared to be no significant difference between the bacterial isolation rates from different breeds of rabbit. Significantly more of the swabs taken from young rabbits yielded cultivable bacteria than did those taken from rabbits over 12 months of age.

Nonprescription tinted eyewear optical accuracy study.

BACKGROUND: Nonprescription tinted eyewear, commonly referred to as noncorrective sunglasses or plano sun eyewear, often induce measurable amounts of prismatic deviation. With high-wrap eyewear this effect becomes more pronounced. The purpose of this project was to assess the amount of horizontal and vertical prismatic deviation induced by some popular premium plano sun eyewear intended for use by athletes. METHODS: Prismatic deviations for two identical pairs of high-wrap, steep base curve, plano sun eyewear from each of six prominent national brands were measured in both primary gaze and along a peripheral line of sight 30 degrees to the right of straight-ahead. RESULTS: Most of the eyewear induced base-out and base-down prism in each lens in primary gaze. All eyewear induced base-in prism with temporal gaze and base-out prism with nasal gaze at 30 degrees laterally. Most eyewear induced base-down prism with lateral gaze as well. CONCLUSIONS: Plano sun eyewear is often purchased for use in bright environments during visually demanding sports, such as golf, baseball, and volleyball. It is well-documented that athletes possess superior visual function as compared to nonathletes or lesser-level athletes. Further studies are indicated to determine the impact of this prism on the average wearer and the elite athlete.

Direct effects of triiodothyronine on human internal mammary artery and saphenous veins.

OBJECTIVE: Thyroid hormone (3,5,3'-triiodo-L-thyronine is under investigation as a positive inotrope and vasodilator for patients undergoing cardiac surgery. This study determined the direct effects of triiodothyronine on human blood vessels. DESIGN: Prospective, controlled, in vitro study. SETTING: Laboratory facility in a university teaching hospital. PARTICIPANTS: Small excess segments of internal mammary arteries or saphenous veins were obtained from patients undergoing coronary artery bypass surgery. INTERVENTIONS: Vessel segments were cut into rings to measure isometric tension development in isolated tissue baths containing Krebs-Ringer bicarbonate solution at 37 degrees C. Rings were prestretched in vitro to resting tensions analogous to mean arterial or central venous pressures in vivo and then constricted with potassium or phenylephrine. Rings were exposed to increasing concentrations of triiodothyronine (4 x 10(-12) to 1 x 10(-4) mol/L) to obtain dose-response curves. MEASUREMENTS AND MAIN RESULTS: High concentrations (> or = 3.3 x 10(-5) mol/L) of trilodothyronine produced dose-dependent relaxation of preconstricted rings. The relaxation was not selective for arteries or veins at arterial resting tensions, and with either potassium or phenylephrine as a vasoconstrictor. Propranolol had little effect on subsequent triiodothyronine-induced relaxation of potassium-constricted rings at resting arterial tensions. CONCLUSIONS: Triiodothyronine, in supraphysiological and suprapharmacological concentrations, dilates preconstricted rings of human blood vessels in vitro; however, triiodothyronine had no demonstrable vasomotor effects on human internal mammary artery or saphenous vein in clinically relevant concentrations (10(-9) to 10(-8) mol/L). Triiodothyronine administration in vivo most likely has little direct effect on the tone of human vascular smooth muscle, particularly coronary artery bypass conduits.

17-beta-estradiol increases mitogenic activity of medium from cultured preadipocytes of massively obese persons.

Having reported that omental preadipocytes from massively obese persons release into the culture medium proteins mitogenic for preadipocytes, this study aimed to determine whether estrogens contribute to the production of these factors. Sub-cultured omental preadipocytes from 13 massively obese women were grown in the presence or absence of 17-beta-estradiol, and during the last 24 h the conditioned medium was prepared in the absence of serum. Media from cells of 8 of 13 subjects contained significantly higher mitogenic activity when grown in the presence of 17-beta-estradiol. 17-Alpha-estradiol was not effective. The bioassay system involved rat perirenal preadipocytes, since these have been well characterized. Partial purification by gel filtration chromatography indicated that the estrogen-dependent factors had Mr greater than 250,000 and approximately 30,000. Thus, estrogens might contribute to the development of massive obesity in genetically susceptible subjects by promoting the production of paracrine/autocrine principles by adipose cells.

Hormonal effects of an induction dose of etomidate for patients undergoing urgent myocardial revascularization.

The use of etomidate for induction of anesthesia in patients requiring urgent coronary artery surgery provides good cardiovascular stability. However, long-term etomidate infusions may cause transient signs of adrenocortical suppression. The purpose of this study was to determine whether an induction bolus dose of etomidate would cause clinically relevant endocrine dysfunction in urgent coronary artery bypass patients. With institutional review board approval, 11 patients were prospectively randomized to a diazepam (control) or etomidate rapid sequence induction. The diazepam group (n=6; mean, 69 years) received 0.4 mg/kg of diazepam. The etomidate group (n=5; mean, 54 years) received 0.3 mg/kg of etomidate. Maintenance anesthesia included nitrous oxide, oxygen, pancuronium, and fentanyl in increments up to 32 microg/kg. Hemodynamics, cortisol, epinephrine, and norepinephrine were measured both intraoperatively and postoperatively. The only significant difference between the two groups in hemodynamic parameters was a higher heart rate in the etomidate group. Both agents adequately controlled the stress response to intubation as judged from the levels of epinephrine, norepinephrine. and cortisol. However, in both groups epinephrine and norepinephrine increased between intubation and removal of the aortic cross-clamp. Cortisol also increased from the time of cross-clamp removal to 12 and 24 hours post-bypass. During anesthesia and surgery in the pre-bypass period, there was a decrease in cortisol over time in the etomidate group, and there was an increase with diazepam. Thus, etomidate provided stable hemodynamics, possible mild intraoperative adrenocortical suppression, a depressed hormonal stress response to intubation, and a normal hormonal reaction to the later part of surgery and the postoperative period.