Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients

IntroductionNo therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment.MethodWe conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions.ResultsPatients with TCZ (n = 20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P = 0.014), presented with more severe forms (higher level of oxygen therapy at 13 L/min vs 6 L/min, P < 0.001), and had poorer biological findings (severe lymphopenia: 676/mm³ vs 914/mm³, P = 0.037 and higher CRP level: 158 mg/L vs 105 mg/L, P = 0.017) than patients without TCZ (n = 25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P = 0.002).ConclusionDespite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.     

Summary-of-findings tables in Cochrane reviews improved understanding and rapid retrieval of key information

ObjectiveTo measure the effects of a summary-of-findings (SoF) table on user satisfaction, understanding, and time spent finding key results in a Cochrane review.Study Design and SettingWe randomized participants in an evidence-based practice workshop (randomized controlled trial [RCT] I) and a Cochrane Collaboration entities meeting (RCT II) to receive a Cochrane review with or without an SoF table. In RCT I, we measured user satisfaction. In RCT II, we measured correct comprehension and time spent finding key results.ResultsRCT I: Participants with the SoF table (n = 47) were more likely to “agree” or “strongly agree” that it was easy to find results for important outcomes than (n = 25) participants without the SoF table—68% vs. 40% (P = 0.021). RCT II: Participants with the SoF table (n = 18) were more likely to correctly answer two questions regarding results than (n = 15) those without the SoF table: 93% vs. 44% (P = 0.003) and 87% vs. 11% (P < 0.001). Participants with the SoF table spent an average of 90 seconds to find key information compared with 4 minutes for participants without the SoF table (P = 0.002).ConclusionIn two small trials, we found that inclusion of an SoF table in a review improved understanding and rapid retrieval of key findings compared with reviews with no SoF table.     

Functional signs in patients consulting for presumed Lyme borreliosis

IntroductionLittle is known about the functional symptoms associated with Lyme borreliosis (LB) in Europe. We aimed to assess functional symptoms associated with presumed LB and to compare patients with and without confirmed LB.Materials and methodsWe performed a retrospective monocenter study. Patients consulting for presumed LB were included.ResultsBetween November 2015 and June 2018, 355 patients were included (mean age: 51 years, 52% of women) of which 48 had LB: erythema migrans (42%), early disseminated LB (50%; 35% of neuroborreliosis cases), and late disseminated LB (8%). The most frequently reported functional symptoms were neuropathic pain (23%), arthralgia (23%), and asthenia (17%). Other functional symptoms were rare (≤ 10%). Three hundred and seven (86%) patients did not have LB. Patients with confirmed LB reported fewer functional symptoms than patients without LB (1.8 (± 1.7) vs. 3.6 (± 2.5), P < 0.001) with a shorter duration of symptoms (< 3 months in 48% vs. 16% of cases, P < 0.001). They less often reported asthenia (17% vs. 59%, P < 0.001), widespread pain (10% vs. 31%, P = 0.003), myalgia (10% vs. 32%, P = 0.002), memory disorders (4% vs. 16%, P = 0.03), irritability (2% vs. 23%, P ± 0.001), and sadness (0% vs. 16%, P = 0.003).ConclusionIn patients consulting for presumed LB, patients diagnosed with LB had fewer and shorter functional symptoms than patients without LB.     

An internet-delivered exercise intervention for workplace health promotion in overweight sedentary employees: A randomized trial

ObjectiveTo evaluate the effect of structured vs. non-structured internet-delivered exercise recommendations on aerobic exercise capacity and cardiovascular risk profile in overweight sedentary employees.Methods140 employees of an automobile company (11% female, median age 48 years (range 25–60), BMI 29.0 kg/m² (25.0–34.8)) were randomized in a 3:2 ratio to an intervention group receiving structured exercise schedules or a control group choosing workouts individually via an interactive website. The 12-week intervention took place in Munich, Germany, during summer 2008. Main outcome measure was performance at the lactate anaerobic threshold (P_AT/kg) during ergometry.Results77 participants completed the study. The intervention group (n = 50) improved significantly in P_AT/kg ((mean (SD)) 1.68 (0.31) vs. 1.81 (0.33) W/kg; p = 0.002), VO₂peak (3.21 (0.63) vs. 3.35 (0.74) L/min; p = 0.04), and waist circumference (100.5 (7.9) vs. 98.0 (7.8) cm; p = 0.001). The control group (n = 27) improved significantly in P_AT/kg (1.59 (0.38) vs. 1.80 (0.49); p < 0.001) and waist circumference (101.9 (8.7) vs. 98.3 (8.5) cm; p < 0.001), but not in VO₂peak. No significant between group differences in these outcome measures were noted.ConclusionStructured, internet-delivered exercise recommendations are not superior to internet-delivered non-structured exercise recommendations in a workplace setting. Both lifestyle intervention strategies are, however, limited by high dropout rates.     

Mode-specific physical activity and leukocyte telomere length among U.S. adults: Implications of running on cellular aging

BackgroundPrevious research demonstrates that physical activity participation is associated with longer leukocyte telomere length, with shorter leukocyte telomere length being a hallmark characteristic of cellular aging. What remains under-investigated, however, is whether there is a mode-specific association of physical activity on leukocyte telomere length, which was this study's purpose.MethodsData from the 1999–2002 National Health and Nutrition Examination Survey were used (N = 6474 adults analyzed). Leukocyte telomere length was assessed using quantitative polymerase chain reaction. Physical activity was assessed via self-report, with participants classified as meeting physical activity guidelines (≥ 2000 metabolic equivalent of task-min-month) for 9 separate physical activities, including aerobics (unweighted percent meeting guidelines: 2.98%; n = 193), basketball (2.0%; n = 129), bicycling (3.71%; n = 240), dance (2.30%; n = 149), running (3.09%; n = 200), stair climbing (1.33%, n = 86), swimming (1.85%, n = 120), walking (13.53%; n = 876), and weight lifting (2.61%; n = 169).ResultsIn a single multivariable linear regression model including the independent variables of age, gender, race-ethnicity, weight status, total cholesterol, C-reactive protein, total metabolic equivalent of task-min-month of physical activity and the 9 binary meeting physical activity guideline variables, the only mode of physical activity that was significantly associated with leukocyte telomere length was meeting physical activity guidelines from running (β = 0.06; 95% CI: 0.01–0.11; P = 0.03).ConclusionRunning-specific physical activity was the only evaluated physical activity associated with leukocyte telomere length, which may provide one potential mechanism (i.e., leukocyte telomere length) through which running-based physical activity may help to prevent cardiovascular disease and premature mortality.     

Staphylococcus aureus infective endocarditis versus bacteremia strains: Subtle genetic differences at stake

Infective endocarditis (IE)⁽¹⁾ is a severe condition complicating 10–25% of Staphylococcus aureus bacteremia. Although host-related IE risk factors have been identified, the involvement of bacterial features in IE complication is still unclear. We characterized strictly defined IE and bacteremia isolates and searched for discriminant features. S. aureus isolates causing community-acquired, definite native-valve IE (n = 72) and bacteremia (n = 54) were collected prospectively as part of a French multicenter cohort. Phenotypic traits previously reported or hypothesized to be involved in staphylococcal IE pathogenesis were tested. In parallel, the genotypic profiles of all isolates, obtained by microarray, were analyzed by discriminant analysis of principal components (DAPC)⁽²⁾. No significant difference was observed between IE and bacteremia strains, regarding either phenotypic or genotypic univariate analyses. However, the multivariate statistical tool DAPC, applied on microarray data, segregated IE and bacteremia isolates: IE isolates were correctly reassigned as such in 80.6% of the cases (C-statistic 0.83, P < 0.001). The performance of this model was confirmed with an independent French collection IE and bacteremia isolates (78.8% reassignment, C-statistic 0.65, P < 0.01). Finally, a simple linear discriminant function based on a subset of 8 genetic markers retained valuable performance both in study collection (86.1%, P < 0.001) and in the independent validation collection (81.8%, P < 0.01). We here show that community-acquired IE and bacteremia S. aureus isolates are genetically distinct based on subtle combinations of genetic markers. This finding provides the proof of concept that bacterial characteristics may contribute to the occurrence of IE in patients with S. aureus bacteremia.     

Evaluation of pneumococcal urinary antigen testing for respiratory tract infection investigations

ObjectiveThe pneumococcal urinary antigen test enables rapid bacteriological diagnosis in respiratory tract infections. The objective was to identify factors associated with a positive pneumococcal urinary antigen test result.Patients and methodsThis seven-year retrospective monocentric study was performed on consecutive patients presenting with respiratory tract infections reported as pneumococcal-positive. Epidemiological, biological, and radiological factors were analyzed, and severity scores were calculated.ResultsA total of 223 patients were included. Significant associations were observed between positive test results and age over 65 years (P = 0.01), positive test results and immunosuppression factors (blood disease [25% Ag+ group vs. 4% Ag− group, P = 0.001], immunosuppressive therapy [10% Ag+ group vs. 0% Ag− group, P = 0.02]). Clinically, fever (64% Ag+ group vs. 42% Ag− group, P = 0.01) and cough (46% Ag+ group vs. 19% Ag− group, P < 0.01) were associated with a positive result, as were radiological alveolar opacities (67% Ag+ group vs. 44% Ag− group, P = 0.01). High PSI score was associated with the Ag+ group (79% vs. 56% Ag− group, P = 0.001).ConclusionAge, immunosuppressive factors, typical pneumococcal symptoms, and PSI scores were associated with a positive pneumococcal urinary antigen result.     

Lack of association between Toll-like receptor 4 gene Asp299Gly and Thr399Ile polymorphisms and tuberculosis susceptibility: A meta-analysis

ObjectiveToll-like receptor 4 (TLR4) plays a vital role in immunity to tubercle bacillus and its gene polymorphisms are supposed to affect tuberculosis susceptibility in some rather than all studies. Then, we integrated published data and performed a comprehensive meta-analysis to get more reliable estimations for the strength of associations between TLR4 gene polymorphisms and the risk of tuberculosis.MethodsWe systematically searched the electronic PubMed database for research articles about TLR4 gene polymorphisms and tuberculosis up to February 2012. Revman 5.0 software was adopted to conduct the meta-analysis. Crude odds ratio (ORs) and 95% confidence intervals (95% CIs) were calculated by either fixed-effects model or random-effects model.ResultsFinally, six case-control studies were identified, involving 1587 controls and 2110 patients. Overall, no significant associations were found between TLR4 gene Asp299Gly polymorphism and tuberculosis in the codominant models (GG vs AA: OR = 1.56, 95% CI = 0.76–3.21, P = 0.23; GA vs AA: OR = 1.01, 95% CI = 0.84–1.23, P = 0.89), the dominant model (GG + GA vs AA: OR = 1.04, 95% CI = 0.80–1.35, P = 0.75), the recessive model (GG vs GA + AA: OR = 1.55, 95% CI = 0.75–3.19, P = 0.24) and the allele model (G vs A: OR = 1.06, 95% CI = 0.81–1.40, P = 0.66). Similarly, no significant associations between TLR4 gene Thr399Ile and tuberculosis were observed (all P > 0.05).ConclusionsThe present meta-analysis suggests that TLR4 gene Asp299Gly and Thr399Ile polymorphisms are not associated with the susceptibility of tuberculosis.     

Annual influenza vaccination reduces total hospitalization in patients with chronic hepatitis B virus infection: A population-based analysis

BackgroundThis study evaluated hospitalization and mortality in patients with chronic hepatitis B virus infection (HBV (+)) and matched comparison patients after stratifying the patients according to annual influenza vaccination (Vaccine (+)).MethodsData from Taiwan's National Health Insurance program from 2000 to 2009 were used to identify HBV(+)/vaccine(+) (n = 4434), HBV(+)/Vaccine(−) (n = 3646), HBV(−)/Vaccine(+) (n = 8868), and HBV(−)/Vaccine(−) (n = 8868) cohorts. The risk of pneumonia/influenza, respiratory failure, intensive care, hospitalization, and mortality in the four cohorts was evaluated.ResultsThe total hospitalization rate was significantly lower in patients with chronic HBV infection who received an annual influenza vaccination than in chronic HBV-infected patients who did not receive an influenza vaccination (16.29 vs. 24.02 per 100 person-years), contributing to an adjusted hazard ratio (HR) of 0.56 (95% confidence interval (CI) = 0.50–0.62). The HBV(+)/Vaccine(+) cohort also had lower risks than the HBV(+)/Vaccine(−) cohort for pneumonia and influenza (adjusted HR = 0.79, 95% CI = 0.67–0.92), intensive care unit admission (adjusted HR = 0.33, 95% CI = 0.25–0.43), and mortality (adjusted HR = 0.19, 95% CI = 0.15–0.24).ConclusionsOur results suggest that annual influenza vaccination can reduce the risk of hospitalization and mortality in patients with chronic HBV infection.     

The MTHFR C677T mutation is not a risk factor recognized for HBV-related HCC in a population with a high prevalence of this genetic marker

BackgroundPolymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene can affect disease progression in HBV infection. However, the results from different reports are inconsistent. The aim of this study was to investigate the association between the MTHFR C677T polymorphism and the outcome of HBV infection in a Tianjin Han population.MethodsTaqMan SNP genotyping was employed to determine the alleles and genotypes of MTHFR C677T in 2511 subjects from various stages of HBV infection and 549 healthy controls.ResultsOf the 3060 subjects, the genotypic frequencies were CT 48.9%, TT 29.3% and CC 21.8%; the allelic frequencies were T 53.8% and C 46.2%. There was no significant difference in genotypic or allelic distribution among the different disease groups. When either healthy subjects or self-limited subjects were used as controls, the TT genotype and the T allele conferred protective effects against hepatocellular carcinoma (HCC) (HCC vs healthy subjects: OR = 0.588, 95% CI = 0.413–0.836, P = 0.003; OR = 0.768, 95% CI = 0.645–0.915, P = 0.003, respectively. HCC vs self-limited subjects: OR = 0.598, 95% CI = 0.404–0.886, P = 0.010; OR = 0.772, 95% CI = 0.635–0.940, P = 0.010, respectively). After sub-stratification by gender, the prevalence of the TT genotype or T allele was the lowest in the male HCC group (TT 23.5%, T 49.8%). The protective effects of the TT genotype and the T allele were observed in male HCC and cirrhotic subjects (HCC vs self-limited subjects: OR = 0.470, 95% CI = 0.288–0.766, P = 0.002; OR = 0.681, 95% CI = 0.535–0.866, P = 0.002, respectively. Liver cirrhosis vs self-limited subjects: OR = 0.624, 95% CI = 0.392–0.992, P = 0.046; OR = 0.791, 95% CI = 0.627–0.998, P = 0.048, respectively), but not in female. When the subjects were stratified according to the clinical features, no statistically significant difference in the genotypic distribution was observed (P > 0.05).ConclusionsThe TT genotype and T allele of MTHFR C677T may confer a protective effect on disease progression to HCC in HBV-infected individuals, especially among male patients, in a population with a high prevalence of this genetic marker.     

Single nucleotide polymorphisms in Plasmodium falciparum V type H+ pyrophosphatase gene (pfvp2) and their associations with pfcrt and pfmdr1 polymorphisms

BackgroundChloroquine resistance in Plasmodium falciparum malaria has been associated with pfcrt 76T (chloroquine resistance transporter gene) and pfmdr1 86Y (multidrug resistance gene 1) alleles. Pfcrt 76T enables transport of protonated chloroquine out of the parasites digestive vacuole resulting in a loss of hydrogen ions (H⁺). V type H⁺ pyrophosphatase (PfVP2) is thought to pump H⁺ into the digestive vacuole. This study aimed to describe the geographic distribution of single nucleotide polymorphisms in pfvp2 and their possible associations with pfcrt and pfmdr1 polymorphisms.MethodsBlood samples from 384 patients collected (1981–2009) in Honduras (n = 35), Colombia (n = 50), Liberia (n = 50), Guinea Bissau (n = 50), Tanzania (n = 50), Iran (n = 50), Thailand (n = 49) and Vanuatu (n = 50) were analysed. The pfcrt 72–76 haplotype, pfmdr1 copy numbers, pfmdr1 N86Y and pfvp2 V405I, K582R and P711S alleles were identified using PCR based methods.ResultsPfvp2 was amplified in 344 samples. The pfvp2 allele proportions were V405 (97%), 405I (3%), K582 (99%), 582R (1%), P711 (97%) and 711S (3%). The number of patients with any of pfvp2 405I, 582R and/or 711S were as follows: Honduras (2/30), Colombia (0/46), Liberia (7/48), Guinea-Bissau (4/50), Tanzania (3/48), Iran (3/50), Thailand (1/49) and Vanuatu (0/31). The alleles were most common in Liberia (P = 0.01) and Liberia + Guinea-Bissau (P = 0.01). The VKP haplotype was found in 189/194 (97%) and 131/145 (90%) samples harbouring pfcrt 76T and pfcrt K76 respectively (P = 0.007).ConclusionsThe VKP haplotype was dominant. Most pfvp2 405I, 582R and 711S SNPs were seen where CQ resistance was not highly prevalent at the time of blood sampling possibly due to greater genetic variation prior to the bottle neck event of spreading CQ resistance. The association between the pfvp2 VKP haplotype and pfcrt 76T, which may indicate that pfvp2 is involved in CQ resistance, should therefore be interpreted with caution.     

Burden of Early-Stage Triple-Negative Breast Cancer in a US Managed Care Plan

ObjectiveTriple-negative breast cancer (TNBC) is a high-grade breast cancer with an aggressive clinical course. We examined the recurrence rate, health care utilization, and cost of early-stage TNBC in the US managed care setting.Study DesignA retrospective study using linked cancer registry, health care claims, and social administration databases.MethodsThis retrospective study used the Impact Intelligence Oncology Management cancer registry, linked to 1999-2009 administrative claims, from a national managed care health plan and also Social Security Administration mortality data. Patients with stage I-III TNBC and non-TNBC were followed from diagnosis to recurrence, disenrollment, or end of observation period. Risk-adjusted recurrence rate, health care utilization, and costs during the follow-up period were compared.ResultsA total of 1967 women (403 with TNBC) were included; 289 (14.7%) had local/distant recurrence during the follow-up period. Patients with TNBC were younger (53.68 vs. 56.16 years, P < .0001) and more likely to experience recurrence compared with non-TNBC (21.6% vs. 12.9%, P < .0001; adjusted hazard ratio = 2.11, P < .0001). In terms of adjusted annual health care utilization and costs, patients with TNBC had significantly higher numbers of hospitalizations (1.20 vs. 0.90, P = .001); hospitalization days (8.80 vs. 4.97, P < .0001); and emergency department (ED) visits (1.45 vs. 0.95, P = .009). They also had significantly higher inpatient costs (all-cause: $9154 vs. $5501; cancer-related: $5632 vs. $2869; P < .0001 for both); and ED costs (all-cause: $303 vs. $182, P = .003; cancer-related: $240 vs. $138, P = .012).ConclusionsThis study demonstrates that, compared with non-TNBC, early-stage TNBC is associated with higher rate of recurrence, resulting in increased health care utilization and costs.     

Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias

ObjectiveTo determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class.LocationCanary Islands.ParticipantsGeneral population cohort, with contacts in 2000 (n = 6,729), 2008 (n = 6,171) and 2015 (n = 4,705).Main measurementsSmoking, gender, age, and social class.ResultsConsumption decreased by 6% (5-7%, P < .001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P < .001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P = .011) and intermediate ages (7% [6-8%], P < .001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P < .001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages.ConclusionsThe evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.     

Impacto sobre el cuidador principal de una intervención realizada a personas mayores dependientes

ObjectiveTo evaluate the impact of joining a home care program on primary caregivers of dependent elderly people.DesignNon-randomised “before-after” intervention study.SettingPrimary Care.ParticipantsPrimary carers of elderly dependent people included in a home care program (n = 156; 7.8% loss to follow up).InterventionsInclusion in a home care program for chronically dependent elderly and the assessment of the primary carer in the same year.Variables assessedperceived health, frequency of visits, questionnaires of quality of life (Nottingham questionnaire), psychological health (Goldberg questionnaire), social support (Duke-UNC scale) and overburden of caregivers (Zarit questionnaire) and satisfaction with care received.ResultsThere were no significant changes in perceived health. Improvement in the areas of energy, sleep, emotional and social relationship of the quality of life. Decreased attendance (8.4 vs. 7.5, p < 0.05) and the percentage of overusers (30.1 vs 6.9%, P < .01). A reduced percentage of caregivers expressed low social support (8.3 vs 2.8%, P < .05) and caregiver overburden (56.4 vs 44.4%, P < .05). 90.3% of caregivers believed that care had improved at the end of intervention, with a significant improvement of satisfaction of overall medical and nursing care received (7.6 vs 8, 4, 7.9 vs 8.5 and 7 vs 8.5; P < .05).ConclusionsJoining a home care program for dependents has a positive impact on their primary caregiver and improves their perception of care received, reducing their use of health services, reducing the level of overburden and their perceived lack of social support.     

Immunization of pregnant women against pertussis: The effect of timing on antibody avidity

BackgroundThe Centers for Disease Control and Prevention recommend tetanus–diphteria–acellular pertussis (Tdap) immunization during pregnancy, preferably at 27–36 weeks gestation.AimsFirst, to assess the relative avidity index (RAI) of umbilical cord immunoglobulin G (IgG) to pertussis toxin (PT) for newborns of women immunized with Tdap during late pregnancy as compared to unimmunized women. Second, to assess whether there is a preferential period of gestational Tdap immunization that provides the highest RAI of umbilical cord IgG to PT.MethodsRAI of IgG to PT was assessed via an adapted ELISA using NH₄SCN as a dissociating agent.ResultsWe found that newborns of women immunized with Tdap during late pregnancy (n = 52) had higher mean RAI of umbilical cord IgG to PT than those of unimmunized women (n = 8), 73.77% ± 12.08 (95% CI, 70.41–77.13) vs. 50.23% ± 21.32 (95% CI, 32.41–68.06), p < 0.001. Further, the RAI of umbilical cord IgG to PT was significantly higher in newborns of women immunized at 27–30⁺⁶ weeks gestation (n = 20) when compared with newborns of women immunized at 31–36 weeks (n = 22) and >36 weeks (n = 7), 79.53% ± 5.61 (95% CI, 76.91–82.16) vs. 71.56% ± 12.58 (95% CI, 65.98–77.14) vs. 63.93% ± 17.98 (95% CI, 47.31–80.56), p < 0.03.ConclusionGestational Tdap immunization between 27 and 30⁺⁶ weeks resulted in the highest avidity of IgG to PT conveyed at delivery as compared with immunization beyond 31 weeks gestation. Future studies should be conducted to confirm our findings to optimize pertussis-controlling strategies.     

Citations to trials of nicotine replacement therapy were biased toward positive results and high-impact-factor journals

ObjectiveTo study variations in the number of times trials of nicotine replacement therapy (NRT) were cited, and which characteristics of trials predicted the number of citations and the impact factors of journals in which articles were published.Study Design and SettingWe used all 105 randomized controlled trials in the Cochrane review of NRT for smoking cessation. We obtained impact factors from the Journal Citation Reports and the number of citations from ISI Web of Knowledge and Google Scholar.ResultsTrials were cited from 0 to 632 times (median 23 times). Trials were cited more often when results were statistically significant than when they were not (median = 41 vs. 17 times, P < 0.001), and when impact factors were higher (10.2 more citations per impact factor point, P < 0.001). Patch trials were cited more often than gum trials (median = 29 vs. 17 times, P = 0.001), and trials funded by the pharmaceutical industry were cited more often than other trials (median = 28 vs. 16.5 times, P = 0.001). Trials with statistically significant results were published in journals with higher impact factors than trials with nonsignificant results (median impact factor = 2.80 vs. 1.81, P = 0.011).ConclusionCitations were biased toward trials with positive results and toward trials published in high-impact-factor journals.     

Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Introduction/ObjectivesAcute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.Materials and methodsThis is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.ResultsAmong the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank < 0.0001). Their relative risks are respectively (HR = 3.25 CI 95% [1.99–5.3] and HR = 2.42 CI 95% [1.5–3.9], p < 0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR = 3.0, 95% CI [1.5–6.1], p = 0.002).ConclusionA possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.     

Association between Fc-gamma receptor IIa (CD32) gene polymorphism and malaria susceptibility: A meta-analysis based on 6928 subjects

BackgroundPrevious studies about the association between the -131R/H polymorphism in the Fc-gamma receptor IIa (FcγRIIa) gene and malaria susceptibility have yielded conflicting results. The aim of this meta-analysis was to clarify more accurately the association of this polymorphism with malaria risk.MethodsA systematic literature search of the associated studies up to August 1, 2013, was conducted using the following electronic databases: PubMed, Embase, Medline, and the China National Knowledge Infrastructure (CNKI). Statistical analyses were performed by STATA12.0 software, with odds ratios (ORs) and their 95% confidence intervals (CIs).ResultsSix eligible studies including 4111 malaria cases and 2817 controls were identified. A pooled analysis of these studies pointed to a significant association between the variant H allele and reduced susceptibility to malaria or possible protection against malaria: H vs. R (OR = 0.691, P_OR = 0.009); HH vs. RR (OR = 0.523, P_OR = 0.013); RH vs. RR (OR = 0.770, P_OR = 0.037); RH + HH vs. RR (OR = 0.664, P_OR = 0.019); and HH vs. RH + RR (OR = 0.649, P_OR = 0.037). In subgroup analysis, similar significant associations were also found in Asia (HH vs. RR: OR = 0.137, P_OR = 0.009; HH vs. RH + RR: OR = 0.267, P_OR = 0.000) and in Africa (RH vs. RR: OR = 0.842, P_OR = 0.002; RH + HH vs. RR: OR = 0.859, P_OR = 0.004).ConclusionsThis meta-analysis suggests that the variant H allele of the FcγRIIa-131R/H polymorphism may be a protective factor against blood-stages of malaria infection, both in Asians and Africans. The finding may aid the development of effective immune protection strategies against malaria that focus on antibody responses and enrich current knowledge of gene polymorphism in the malaria. Further large and well-designed studies are needed to confirm this association.     

Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas

ObjectiveTo evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community.DesignRandomised clinical trial.SettingFamily health centre, primary care.ParticipantsIndependent elderly people living in the community.InterventionFor intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre.Main measurementsPerception of risk of falls, number of risk factors and number of falls in the study period.ResultsIn both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004).ConclusionsThe multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.