Cardiovascular morbidity and mortality in lean vs. non-lean MASLD: A comprehensive meta-analysis

BACKGROUND

Lean metabolic dysfunction-associated steatotic liver disease (MASLD), characterized by a BMI < 25 kg/m² (or < 23 kg/m² in Asians), presents a challenging prognosis compared to non-lean MASLD. This study examines cardiovascular outcomes in both lean and non-lean MASLD cohorts.

METHODS

In this meta-analysis, pooled odds ratios (ORs) within 95 % confidence intervals (CIs) were calculated for primary outcomes (cardiovascular mortality and major adverse cardiovascular events [MACE]) and secondary outcomes (cardiovascular disease [CVD], all-cause mortality, hypertension, and dyslipidemia). Studies comparing lean and non-lean MASLD within the same cohorts were analyzed, prioritizing those with larger sample sizes or recent publication dates.

RESULTS

Twenty-one studies were identified, encompassing lean MASLD patients (n = 7153; mean age 52.9 ± 7.4; 56 % male) and non-lean MASLD patients (n = 23,514; mean age 53.2 ± 6.8; 63 % male). Lean MASLD exhibited a 50 % increase in cardiovascular mortality odds compared to non-lean MASLD (OR: 1.5, 95 % CI 1.2-1.8; p < 0.0001). MACE odds were 10 % lower in lean MASLD (OR: 0.9, 95 % CI 0.7-1.2; p = 0.7), while CVD odds were 40 % lower (p = 0.01). All-cause mortality showed a 40 % higher odds in lean MASLD versus non-lean MASLD (p = 0.06). Lean MASLD had 30 % lower odds for both hypertension (p = 0.01) and dyslipidemia (p = 0.02) compared to non-lean MASLD.

CONCLUSION

Despite a favorable cardiometabolic profile and comparable MACE rates, lean individuals with MASLD face elevated cardiovascular mortality risk.

First Measurement of η Meson Production in Neutrino Interactions on Argon with MicroBooNE

We present a measurement of η production from neutrino interactions on argon with the MicroBooNE detector. The modeling of resonant neutrino interactions on argon is a critical aspect of the neutrino oscillation physics program being carried out by the DUNE and Short Baseline Neutrino programs. η production in neutrino interactions provides a powerful new probe of resonant interactions, complementary to pion channels, and is particularly suited to the study of higher-order resonances beyond the Δ(1232). We measure a flux-integrated cross section for neutrino-induced η production on argon of 3.22±0.84(stat)±0.86(syst) 10^{-41}  cm^{2}/nucleon. By demonstrating the successful reconstruction of the two photons resulting from η production, this analysis enables a novel calibration technique for electromagnetic showers in GeV accelerator neutrino experiments.

A randomized controlled trial on the effectiveness of laparoscopic-guided transversus abdominis plane block in patients undergoing laparoscopic IPOM plus

INTRODUCTION

Ventral hernia repairs, particularly laparoscopic ventral hernia repair (LVHR), have become common procedures among general surgeons worldwide. Despite the benefits of LVHR, acute postoperative pain remains a significant concern. Transversus abdominis plane (TAP) blocks have been employed to alleviate postoperative pain in various laparoscopic procedures. This study aimed to assess the effectiveness of laparoscopic-guided TAP block in laparoscopic IPOM plus and its impact on postoperative pain and analgesic requirements.

MATERIALS AND METHODS

A randomized controlled trial was conducted at a tertiary care center in India involving 72 patients undergoing laparoscopic IPOM plus. Patients were randomized into two groups: Group I received laparoscopic-guided TAP block, while Group II received standard general anesthesia without TAP block. Pain scores were assessed at 6, 12, and 24 h postoperatively using the numerical rating scale. Postoperative analgesic requirements were also recorded.

RESULTS

Group I demonstrated significantly lower pain scores at 6 and 24 h postoperatively compared to Group II. The need for additional analgesics was significantly lower in Group I (13.8%) compared to Group II (72.2%). There were no significant differences in age, BMI, duration of surgery, or other demographic characteristics between the two groups.

CONCLUSION

The findings of this randomized controlled trial demonstrate the effectiveness of laparoscopic-guided TAP blocks in reducing postoperative pain and analgesic requirements after laparoscopic IPOM plus.

Dosimetric and radiobiological comparison of IMRT, VMAT, and helical tomotherapy planning techniques in hippocampal sparing whole brain radiotherapy with simultaneous integrated boost for multiple brain metastases

To compare treatment planning and dosimetric outcomes for hippocampal sparing whole brain radiotherapy (WBRT) with the simultaneous integrated boost (SIB) in brain metastasis (BM) patients using tumour control probability (TCP) and normal tissue complication probability (NTCP) formalism between IMRT, VMAT, and HT techniques. In this retrospective study, the treatment data of 20 BM patients who typically received whole brain radiation with SIB treatment were used. Prescription doses of 30 Gy and 36 Gy was delivered in 10 fractions for WBRT and SIB, respectively. Niemierko and LKB models were applied for calculating TCP and NTCP. All the plans were evaluated for the RTOG 0933 protocol criteria and found acceptable. Additionally, the homogeneity of the PTV boost is 0.07 ± 0.01, 0.1 ± 0.04, and 0.08 ± 0.02 for IMRT, VMAT, and HT, respectively (P < 0.05). The percentage of TCP for the PTV boost was 99.99 ± 0.003, 99.98 ± 0.004, and 99.99 ± 0.002 of IMRT, VMAT, and HT, respectively, (P < 0.005). The NTCP value of the lenses was higher with the VMAT plan as compared to IMRT and HT Plans. The hippocampal NTCP values are equal in all three planning proficiencies. The techniques like IMRT, VMAT, and HT can reduce the dose received by hippocampus to the dosimetric threshold during the delivery of WBRT with hippocampal sparing and can simultaneously boost multiple metastases. Overall, the high-quality dose distribution, TCP, and NTCP comparison between all three planning techniques show that the HT technique has better results when compared to the VMAT and IMRT techniques.

Temporal trends and procedural safety of transcatheter mitral valve repair with mitraclip in patients with hypertrophic cardiomyopathy: Insights from the national inpatient sample

Data on utilization and safety of mitral Transcatheter Edge-to-Edge Repair (TEER) among hypertrophic cardiomyopathy (HCM) patients is limited. Our study aimed to assess the national utilization, safety, and clinical outcomes of TEER procedures among HCM patients using a nationwide real-world cohort. HCM patients undergoing TEER hospitalizations between 2015-2020 were identified using ICD-10 (International Classification of Diseases, (ICD-10-CM/PCS). HCM-TEER and HCM No-TEER formed the two comparison groups. Demographic characteristics, baseline comorbidities, procedural complications, inpatient mortality, length of stay (LOS), and cost of hospitalization were compared between the propensity-matched cohorts. Numeric values of 10 or less were not reported per NIS data use agreements. A total of 39,625 weighted cases of TEER were identified from 2015-2020. Of the included patients, 335 patients had the HCM diagnosis. The median age of the HCM-TEER group was 74 (70-79) vs. 79 (72-85) for the no-TEER cohort. The TEER procedure was more frequently performed among Caucasians (86.57%) and females (53.73%). The TEER procedure among HCM patients had similar in-hospital mortality (Adjusted odds ratio: aOR 1.50, 95% CI [0.68-3.29]; p = 0.30) and net adverse cardiac events (NACE) (aOR 1.16, 95% CI [0.73-1.85]; p = 0.51). TEER among HCM was associated with higher odds of gastrointestinal/hematological (aOR 2.33, 95% CI [1.29-4.19]; p = 0.003) complications. However, the odds of cardiac complications (aOR 0.57, 95% CI [0.33-0.96]; p = 0.03) were not higher. The median length of stay was similar in both the groups (median: 2 vs. 2, p = 0.74), although TEER among HCM was associated with higher costs of hospitalization ($44729.36 vs. $40513.82, p < 0.01). TEER is a minimally invasive procedure and could be a safe option for symptomatic HCM patients with significant MR who are poor surgical candidates. Mitral TEER among HCM has been increasingly utilized in recent years in the United States more commonly in obstructive HCM and is associated with no difference in mortality and net adverse cardiac events but higher odds for gastrointestinal/hematological complications than non-HCM patients.

Search for Heavy Neutral Leptons in Electron-Positron and Neutral-Pion Final States with the MicroBooNE Detector

We present the first search for heavy neutral leptons (HNLs) decaying into νe^{+}e^{-} or νπ^{0} final states in a liquid-argon time projection chamber using data collected with the MicroBooNE detector. The data were recorded synchronously with the NuMI neutrino beam from Fermilab's main injector corresponding to a total exposure of 7.01×10^{20} protons on target. We set upper limits at the 90% confidence level on the mixing parameter |U_{μ4}|^{2} in the mass ranges 10≤m_{HNL}≤150  MeV for the νe^{+}e^{-} channel and 150≤m_{HNL}≤245  MeV for the νπ^{0} channel, assuming |U_{e4}|^{2}=|U_{τ4}|^{2}=0. These limits represent the most stringent constraints in the mass range 35 Collapse

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Affiliation(s)

P Abratenko Tufts University, Medford, Massachusetts 02155, USA
O Alterkait Tufts University, Medford, Massachusetts 02155, USA
D Andrade Aldana Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
L Arellano The University of Manchester, Manchester M13 9PL, United Kingdom
J Asaadi University of Texas, Arlington, Texas 76019, USA
A Ashkenazi Tel Aviv University, Tel Aviv, Israel, 69978
S Balasubramanian Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
B Baller Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
G Barr University of Oxford, Oxford OX1 3RH, United Kingdom
D Barrow University of Oxford, Oxford OX1 3RH, United Kingdom
J Barrow Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA Tel Aviv University, Tel Aviv, Israel, 69978
V Basque Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
O Benevides Rodrigues Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
S Berkman Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA Michigan State University, East Lansing, Michigan 48824, USA
A Bhanderi The University of Manchester, Manchester M13 9PL, United Kingdom
A Bhat University of Chicago, Chicago, Illinois 60637, USA
M Bhattacharya Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
M Bishai Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
A Blake Lancaster University, Lancaster LA1 4YW, United Kingdom
B Bogart University of Michigan, Ann Arbor, Michigan 48109, USA
T Bolton Kansas State University (KSU), Manhattan, Kansas 66506, USA
J Y Book Harvard University, Cambridge, Massachusetts 02138, USA
M B Brunetti University of Warwick, Coventry CV4 7AL, United Kingdom
L Camilleri Columbia University, New York, New York 10027, USA
Y Cao The University of Manchester, Manchester M13 9PL, United Kingdom
D Caratelli University of California, Santa Barbara, California 93106, USA
F Cavanna Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
G Cerati Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
A Chappell University of Warwick, Coventry CV4 7AL, United Kingdom
Y Chen SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
J M Conrad Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
M Convery SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
L Cooper-Troendle University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
J I Crespo-Anadón Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid E-28040, Spain
R Cross University of Warwick, Coventry CV4 7AL, United Kingdom
M Del Tutto Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
S R Dennis University of Cambridge, Cambridge CB3 0HE, United Kingdom
P Detje University of Cambridge, Cambridge CB3 0HE, United Kingdom
A Devitt Lancaster University, Lancaster LA1 4YW, United Kingdom
R Diurba Universität Bern, Bern CH-3012, Switzerland
Z Djurcic Argonne National Laboratory (ANL), Lemont, Illinois 60439, USA
R Dorrill Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
K Duffy University of Oxford, Oxford OX1 3RH, United Kingdom
S Dytman University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
B Eberly University of Southern Maine, Portland, Maine 04104, USA
P Englezos Rutgers University, Piscataway, New Jersey 08854, USA
A Ereditato University of Chicago, Chicago, Illinois 60637, USA Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J J Evans The University of Manchester, Manchester M13 9PL, United Kingdom
R Fine Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
O G Finnerud The University of Manchester, Manchester M13 9PL, United Kingdom
W Foreman Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
B T Fleming University of Chicago, Chicago, Illinois 60637, USA
D Franco University of Chicago, Chicago, Illinois 60637, USA
A P Furmanski University of Minnesota, Minneapolis, Minnesota 55455, USA
F Gao University of California, Santa Barbara, California 93106, USA
D Garcia-Gamez Universidad de Granada, Granada E-18071, Spain
S Gardiner Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
G Ge Columbia University, New York, New York 10027, USA
S Gollapinni Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
E Gramellini The University of Manchester, Manchester M13 9PL, United Kingdom
P Green University of Oxford, Oxford OX1 3RH, United Kingdom
H Greenlee Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
L Gu Lancaster University, Lancaster LA1 4YW, United Kingdom
W Gu Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
R Guenette The University of Manchester, Manchester M13 9PL, United Kingdom
P Guzowski The University of Manchester, Manchester M13 9PL, United Kingdom
L Hagaman University of Chicago, Chicago, Illinois 60637, USA
O Hen Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
C Hilgenberg University of Minnesota, Minneapolis, Minnesota 55455, USA
G A Horton-Smith Kansas State University (KSU), Manhattan, Kansas 66506, USA
Z Imani Tufts University, Medford, Massachusetts 02155, USA
B Irwin University of Minnesota, Minneapolis, Minnesota 55455, USA
M Ismail University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
C James Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
X Ji Nankai University, Nankai District, Tianjin 300071, China
J H Jo Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
R A Johnson University of Cincinnati, Cincinnati, Ohio 45221, USA
Y-J Jwa Columbia University, New York, New York 10027, USA
D Kalra Columbia University, New York, New York 10027, USA
N Kamp Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
G Karagiorgi Columbia University, New York, New York 10027, USA
W Ketchum Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
M Kirby Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
T Kobilarcik Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
I Kreslo Universität Bern, Bern CH-3012, Switzerland
M B Leibovitch University of California, Santa Barbara, California 93106, USA
I Lepetic Rutgers University, Piscataway, New Jersey 08854, USA
J-Y Li University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
K Li Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
Y Li Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
K Lin Rutgers University, Piscataway, New Jersey 08854, USA
B R Littlejohn Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
H Liu Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
W C Louis Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
X Luo University of California, Santa Barbara, California 93106, USA
C Mariani Center for Neutrino Physics, Virginia Tech, Blacksburg, Viriginia 24061, USA
D Marsden The University of Manchester, Manchester M13 9PL, United Kingdom
J Marshall University of Warwick, Coventry CV4 7AL, United Kingdom
N Martinez Kansas State University (KSU), Manhattan, Kansas 66506, USA
D A Martinez Caicedo South Dakota School of Mines and Technology (SDSMT), Rapid City, South Dakota 57701, USA
S Martynenko Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
A Mastbaum Rutgers University, Piscataway, New Jersey 08854, USA
I Mawby University of Warwick, Coventry CV4 7AL, United Kingdom
N McConkey University College London, London WC1E 6BT, United Kingdom
V Meddage Kansas State University (KSU), Manhattan, Kansas 66506, USA
J Micallef Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA Tufts University, Medford, Massachusetts 02155, USA
K Miller University of Chicago, Chicago, Illinois 60637, USA
A Mogan Colorado State University, Fort Collins, Colorado 80523, USA
T Mohayai Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA Indiana University, Bloomington, Indiana 47405, USA
M Mooney Colorado State University, Fort Collins, Colorado 80523, USA
A F Moor University of Cambridge, Cambridge CB3 0HE, United Kingdom
C D Moore Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
L Mora Lepin The University of Manchester, Manchester M13 9PL, United Kingdom
M M Moudgalya The University of Manchester, Manchester M13 9PL, United Kingdom
S Mulleriababu Universität Bern, Bern CH-3012, Switzerland
D Naples University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
A Navrer-Agasson The University of Manchester, Manchester M13 9PL, United Kingdom
N Nayak Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
M Nebot-Guinot University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
J Nowak Lancaster University, Lancaster LA1 4YW, United Kingdom
N Oza Columbia University, New York, New York 10027, USA
O Palamara Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
N Pallat University of Minnesota, Minneapolis, Minnesota 55455, USA
V Paolone University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
A Papadopoulou Argonne National Laboratory (ANL), Lemont, Illinois 60439, USA
V Papavassiliou New Mexico State University (NMSU), Las Cruces, New Mexico 88003, USA
H B Parkinson University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
S F Pate New Mexico State University (NMSU), Las Cruces, New Mexico 88003, USA
N Patel Lancaster University, Lancaster LA1 4YW, United Kingdom
Z Pavlovic Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
E Piasetzky Tel Aviv University, Tel Aviv, Israel, 69978
I Pophale Lancaster University, Lancaster LA1 4YW, United Kingdom
X Qian Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
J L Raaf Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
V Radeka Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
A Rafique Argonne National Laboratory (ANL), Lemont, Illinois 60439, USA
M Reggiani-Guzzo University of Edinburgh, Edinburgh EH9 3FD, United Kingdom The University of Manchester, Manchester M13 9PL, United Kingdom
L Ren New Mexico State University (NMSU), Las Cruces, New Mexico 88003, USA
L Rochester SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
J Rodriguez Rondon South Dakota School of Mines and Technology (SDSMT), Rapid City, South Dakota 57701, USA
M Rosenberg Tufts University, Medford, Massachusetts 02155, USA
M Ross-Lonergan Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
C Rudolf von Rohr Universität Bern, Bern CH-3012, Switzerland
I Safa Columbia University, New York, New York 10027, USA
G Scanavini Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
D W Schmitz University of Chicago, Chicago, Illinois 60637, USA
A Schukraft Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
W Seligman Columbia University, New York, New York 10027, USA
M H Shaevitz Columbia University, New York, New York 10027, USA
R Sharankova Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J Shi University of Cambridge, Cambridge CB3 0HE, United Kingdom
E L Snider Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
M Soderberg Syracuse University, Syracuse, New York 13244, USA
S Söldner-Rembold The University of Manchester, Manchester M13 9PL, United Kingdom
J Spitz University of Michigan, Ann Arbor, Michigan 48109, USA
M Stancari Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J St John Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
T Strauss Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
A M Szelc University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
W Tang University of Tennessee, Knoxville, Tennessee 37996, USA
N Taniuchi University of Cambridge, Cambridge CB3 0HE, United Kingdom
K Terao SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
C Thorpe Lancaster University, Lancaster LA1 4YW, United Kingdom The University of Manchester, Manchester M13 9PL, United Kingdom
D Torbunov Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
D Totani University of California, Santa Barbara, California 93106, USA
M Toups Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
Y-T Tsai SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
J Tyler Kansas State University (KSU), Manhattan, Kansas 66506, USA
M A Uchida University of Cambridge, Cambridge CB3 0HE, United Kingdom
T Usher SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
B Viren Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
M Weber Universität Bern, Bern CH-3012, Switzerland
H Wei Louisiana State University, Baton Rouge, Louisiana 70803, USA
A J White University of Chicago, Chicago, Illinois 60637, USA
S Wolbers Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
T Wongjirad Tufts University, Medford, Massachusetts 02155, USA
M Wospakrik Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
K Wresilo University of Cambridge, Cambridge CB3 0HE, United Kingdom
W Wu University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
E Yandel University of California, Santa Barbara, California 93106, USA
T Yang Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
L E Yates Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
H W Yu Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
G P Zeller Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J Zennamo Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
C Zhang Brookhaven National Laboratory (BNL), Upton, New York 11973, USA

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Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis

INTRODUCTION

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known.

METHODS

We queried Nationwide Inpatient Sample (NIS) from 2009-2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality.

RESULTS

Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (n = 17,775, 77%). On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36-1.52), AKI (aOR 1.53, 95% CI 1.48-1.58), pressor requirement (aOR 1.37, 95% CI 1.25-1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40-0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73-0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS.

CONCLUSION

MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.

Safety and Efficacy of Direct Oral Anticoagulants Versus Warfarin for Atrial Fibrillation in End-Stage Renal Disease on Hemodialysis: A Meta-Analysis of Randomized Control Trials

End-stage renal disease (ESRD) and atrial fibrillation (AF) are commonly encountered, with ESRD itself serving as a well-established risk factor for AF.1 The 2018 AF guidelines have recommended apixaban across all the spectrums of renal impairment, including patients on hemodialysis (HD), and the 2019 American Heart Association/American College of Cardiology/Heart Rhythm Society updated guidelines have suggested careful consideration of reduced dose of direct oral anticoagulants (DOACs) in patients with ESRD.2,3 The current data on the safety and efficacy of warfarin versus DOACs in patients with AF with ESRD and HD is variable. This study aimed to perform a study-level meta-analysis to evaluate the effectiveness and safety of warfarin and DOACs in patients with AF who require dialysis.

Surgical Outcomes of Septal Myectomy With and Without Mitral Valve Surgeries in Hypertrophic Cardiomyopathy: a National Propensity-Matched Analysis (2005 to 2020)

The management of concomitant mitral valve (MV) disease in patients with hypertrophic cardiomyopathy (HCM) remains controversial. The 2020 American Heart Association/American College of Cardiology HCM guidelines recommend that MV replacement (MVR) at the time of myectomy should not be performed for the sole purpose of relieving outflow obstruction. At the national level, limited data exist on the surgical outcomes of MV repair/replacement in patients with HCM who underwent septal myectomy (SM). Hospitalizations of patients with HCM who underwent SM between 2005 and 2020 were identified using International Classification of Diseases, Ninth and Tenth Revision codes (International Classification of Diseases, Ninth and Tenth Revision Clinical Modification/Procedure Coding System). The 3 comparison cohorts were SM alone, MV repair, and MVR with concomitant SM. After propensity matching, 2 cohorts, SM + MVR versus SM + MV repair, were studied for surgical outcomes. Demographic characteristics, baseline co-morbidities, procedural complications, inpatient mortality, length of stay, and cost of hospitalization were compared between the propensity-matched cohorts. A total of 16,797 SM procedures were identified from 2005 to 2020. Among them, 11,470 hospitalizations had SM alone (68.2%), SM + MVR was seen in 3,101 (18.4%), and SM + MV repair comprised 2,226 (13.2%). After propensity matching, the MVR and MV repair formed the matched cohorts of 1,857. There were no significant differences in the odds of cardiogenic shock (adjusted odds ratio [aOR] 0.88, 95% confidence interval [CI] 0.63 to 1.24, p = 0.49), mechanical circulatory support requirement (aOR 0.58, 95% CI 0.37 to 0.90, p = 0.015), stroke (aOR 1.27, 95% CI 0.81 to 1.99, p = 0.29), and major bleeding (aOR 0.52, 95% CI 0.34 to 0.79, p = 0.0026) between the comparison groups. MVR, compared with MV repair, was associated with a higher risk of procedural mortality (8.02% vs 3.18%, aOR 2.98, 95% CI 2.05 to 4.33, p <0.0001), complete heart block (16.36% vs 12.15%, aOR 1.76, 95% CI 1.44 to 2.12, p <0.0001), and the need for permanent pacemaker (16.39% vs 10.62%, aOR 1.83, 95% CI 1.41 to 2.38, p <0.0001). The total length of hospital stay and median hospitalization cost was higher in the MVR group. SM in HCM concomitant with MVR is associated with higher procedural mortality and in-hospital complication risk. These real-world data support the 2020 American Heart Association/American College of Cardiology guidelines that in patients who are candidates for surgical myectomy, MVR should not be performed as part of the operative strategy for relieving outflow obstruction in HCM.

First Double-Differential Measurement of Kinematic Imbalance in Neutrino Interactions with the MicroBooNE Detector

We report the first measurement of flux-integrated double-differential quasielasticlike neutrino-argon cross sections, which have been made using the Booster Neutrino Beam and the MicroBooNE detector at Fermi National Accelerator Laboratory. The data are presented as a function of kinematic imbalance variables which are sensitive to nuclear ground-state distributions and hadronic reinteraction processes. We find that the measured cross sections in different phase-space regions are sensitive to different nuclear effects. Therefore, they enable the impact of specific nuclear effects on the neutrino-nucleus interaction to be isolated more completely than was possible using previous single-differential cross section measurements. Our results provide precision data to help test and improve neutrino-nucleus interaction models. They further support ongoing neutrino-oscillation studies by establishing phase-space regions where precise reaction modeling has already been achieved.

Personalized Postacute Hospitalization Recovery: A Novel Intervention to Improve Patient Experience and Reduce Cost

GOAL

Readmissions are a significant financial burden for payers. Cardiovascular-related discharges are particularly prone to readmission. Posthospital discharge support can impact patient recovery and probably reduce patient readmissions. This study aimed to address the underlying behavioral and psychosocial factors that can negatively affect patients after discharge.

METHODS

The study population was adult patients admitted to the hospital with a cardiovascular diagnosis who had a plan to discharge home. Those who consented to participate were randomized to intervention or control groups on a 1:1 basis. The intervention group received behavioral and emotional support, whereas the control group received usual care. Interventions included motivational interviewing, patient activation, empathetic communication, addressing mental health and substance use, and mindfulness.

PRINCIPAL FINDINGS

Observed total readmission costs were significantly lower in the intervention group than in the control group ($1.1 million vs. $2.0 million) as was the observed mean cost per readmitted patient ($44,052 vs. $91,278). The mean expected cost of readmission after adjustment for confounding variables was lower in the intervention group than in the control group ($8,094 vs. $9,882, p = .011).

PRACTICAL APPLICATIONS

Readmissions are a costly spend category. In this study, posthospital discharge support addressing the psychosocial factors contributing to patients' readmissions resulted in a lower total cost of care for those with a cardiovascular diagnosis. We describe an intervention that is reproducible and can be scaled broadly through technology to reduce readmission costs.

First Measurement of Quasielastic Λ Baryon Production in Muon Antineutrino Interactions in the MicroBooNE Detector

We present the first measurement of the cross section of Cabibbo-suppressed Λ baryon production, using data collected with the MicroBooNE detector when exposed to the neutrinos from the main injector beam at the Fermi National Accelerator Laboratory. The data analyzed correspond to 2.2×10^{20} protons on target running in neutrino mode, and 4.9×10^{20} protons on target running in anti-neutrino mode. An automated selection is combined with hand scanning, with the former identifying five candidate Λ production events when the signal was unblinded, consistent with the GENIE prediction of 5.3±1.1 events. Several scanners were employed, selecting between three and five events, compared with a prediction from a blinded Monte Carlo simulation study of 3.7±1.0 events. Restricting the phase space to only include Λ baryons that decay above MicroBooNE's detection thresholds, we obtain a flux averaged cross section of 2.0_{-1.7}^{+2.2}×10^{-40}  cm^{2}/Ar, where statistical and systematic uncertainties are combined.

Pertussis in India: Past, Present, and Future

While vaccines have markedly reduced the incidence of pertussis, a resurgence has occurred in many countries. Until recently, pertussis has not been recognized as an important public health challenge in India due to its successful infant immunization program. However, India still accounts for a large proportion of the world's cases, and increasing reports of pertussis in other countries and in neonates have regenerated interest in pertussis among Indian authorities. The Global Pertussis Initiative (GPI) Annual Meeting was held virtually in October 2020, in part, to gain a better understanding of the epidemiology and disease burden of pertussis and to explore opportunities to improve its prevention in India. There was a consensus that pertussis cases are being underestimated in India due to multiple factors, such as a reliance on passive surveillance and diagnostic challenges. India offers both whole-cell pertussis and acellular pertussis vaccines, but vaccine coverage is inconsistent across regions due to differences in vaccine availability, access to health care, and regional administrative challenges. This report summarizes the outcomes and considers the key clinical implications of this meeting. The GPI agreed that active surveillance of pertussis in India would be optimal and recommended several studies, including serosurveillance among women of reproductive age to assess the prevalence of recent pertussis infection and to enable policy changes that will enhance the rational use of acellular and whole-cell vaccines. It also recommended engagement with nongovernmental organizations in order to encourage pregnancy immunization in the public sector. To achieve effective control of pertussis in the future, the GPI recognizes there are opportunities to characterize the burden of pertussis in India appropriately and increase vaccination coverage in multiple age groups.

Differentiating Multisystem Inflammatory Syndrome in Children (MIS-C) and Its Mimics - A Single-Center Experience From a Tropical Setting

OBJECTIVES

Identifying clinical and laboratory indicators that differentiate multisystem inflam-matory syndrome in children (MIS-C) apart from other febrile diseases in a tropical hospital setting.

METHODS

Review of hospital records done in a tertiary care exclusive children's hospital for children admitted from April, 2020 till June, 2021. Laboratory values, severe acute respiratory syndrome coronavirus (SARS-CoV-2) serological status, and clinical signs and symptoms of patients with MIS-C, and those with similar presentations were analyzed.

RESULTS

114 children fulfilled the inclusion criteria (age group of 1 mo-18 y) for whom a diagnosis of MIS-C was considered in the emergency room based on the clinical features. Among them, 64 children had the final diagnosis of MIS-C, and the remaining 50 children had confirmatory evidence of infections mimicking MIS-C such as enteric fever, scrub typhus, dengue and appendicitis.

CONCLUSION

Older age group, presence of muco-cutaneous symptoms, very high C-reactive protein, neutrophilic leukocytosis, abdominal pain and absence of hepatosplenomegaly favor a diagnosis of MIS-C.

First Constraints on Light Sterile Neutrino Oscillations from Combined Appearance and Disappearance Searches with the MicroBooNE Detector

We present a search for eV-scale sterile neutrino oscillations in the MicroBooNE liquid argon detector, simultaneously considering all possible appearance and disappearance effects within the 3+1 active-to-sterile neutrino oscillation framework. We analyze the neutrino candidate events for the recent measurements of charged-current ν_{e} and ν_{μ} interactions in the MicroBooNE detector, using data corresponding to an exposure of 6.37×10^{20} protons on target from the Fermilab booster neutrino beam. We observe no evidence of light sterile neutrino oscillations and derive exclusion contours at the 95% confidence level in the plane of the mass-squared splitting Δm_{41}^{2} and the sterile neutrino mixing angles θ_{μe} and θ_{ee}, excluding part of the parameter space allowed by experimental anomalies. Cancellation of ν_{e} appearance and ν_{e} disappearance effects due to the full 3+1 treatment of the analysis leads to a degeneracy when determining the oscillation parameters, which is discussed in this Letter and will be addressed by future analyses.

A Dosimetric and Radiobiological Comparison of Intensity Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Helical Tomotherapy Planning Techniques in Synchronous Bilateral Breast Cancer

OBJECTIVE

The present investigation intends to identify the optimal radiotherapy treatment plan for synchronous bilateral breast cancer (SBBC) using dosimetric and radiobiological indexes for three techniques, namely, helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and intensity-modulated radiotherapy (IMRT).

METHODS

Twenty SBBC treated female patients treatment planning data (average age of 52.5 years) were used as the sample for the present study. Three different plans were created using 50 Gy in a 25 fraction dose regime. Poisson, Niemierko, and LKB models were applied for calculating normal tissue complication probability (NTCP) and tumour control probability (TCP).

RESULT

The target average dose comparison between IMRT with HT and VMAT with HT was highly substantial (P=0.001). The percentage of TCP for IMRT, VMAT, and HT in the Poisson model were 93.70±0.28, 94.68±0.30, and 94.34±0.57, respectively (p<0.05). The dose maximum was lower for the whole lung in the HT plan, with an average dose of 49.31Gy±3.9 (p<0.009). The NTCP values of both Niemierko and LKB models were lower for the heart, lungs, and liver for the IMRT plan.

CONCLUSION

The sparing of organs at risk was higher in the HT plan dosimetrically, and the TCP was higher in the three techniques. The comparison between the three techniques shows that the IMRT and HT techniques could be considered for treating SBBC.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Search for an Excess of Electron Neutrino Interactions in MicroBooNE Using Multiple Final-State Topologies

We present a measurement of ν_{e} interactions from the Fermilab Booster Neutrino Beam using the MicroBooNE liquid argon time projection chamber to address the nature of the excess of low energy interactions observed by the MiniBooNE Collaboration. Three independent ν_{e} searches are performed across multiple single electron final states, including an exclusive search for two-body scattering events with a single proton, a semi-inclusive search for pionless events, and a fully inclusive search for events containing all hadronic final states. With differing signal topologies, statistics, backgrounds, reconstruction algorithms, and analysis approaches, the results are found to be either consistent with or modestly lower than the nominal ν_{e} rate expectations from the Booster Neutrino Beam and no excess of ν_{e} events is observed.

First Measurement of Energy-Dependent Inclusive Muon Neutrino Charged-Current Cross Sections on Argon with the MicroBooNE Detector

We report a measurement of the energy-dependent total charged-current cross section σ(E_{ν}) for inclusive muon neutrinos scattering on argon, as well as measurements of flux-averaged differential cross sections as a function of muon energy and hadronic energy transfer (ν). Data corresponding to 5.3×10^{19} protons on target of exposure were collected using the MicroBooNE liquid argon time projection chamber located in the Fermilab booster neutrino beam with a mean neutrino energy of approximately 0.8 GeV. The mapping between the true neutrino energy E_{ν} and reconstructed neutrino energy E_{ν}^{rec} and between the energy transfer ν and reconstructed hadronic energy E_{had}^{rec} are validated by comparing the data and Monte Carlo (MC) predictions. In particular, the modeling of the missing hadronic energy and its associated uncertainties are verified by a new method that compares the E_{had}^{rec} distributions between data and a MC prediction after constraining the reconstructed muon kinematic distributions, energy, and polar angle to those of data. The success of this validation gives confidence that the missing energy in the MicroBooNE detector is well modeled and underpins first-time measurements of both the total cross section σ(E_{ν}) and the differential cross section dσ/dν on argon.

Epidemiology of Multidrug Resistance among Salmonella enterica serovars typhi and paratyphi A at a Tertiary Pediatric Hospital in India Over a Decade; In-silico Approach to Elucidate the Molecular Mechanism of Quinolone Resistance

BACKGROUND

Enteric fever caused by Salmonella enterica serovar typhi and Salmonella enterica serovar paratyphi A remains one of the most common causes of community-acquired bloodstream infection among children in India. Multidrug resistance is emerging and is a cause of concern as it affects the choice of treatment in enteric fever.

METHOD

In this study, a 10-year analysis of resistance patterns was done along with in-silico homology modeling and molecular docking to understand the commonly occurring quinolone resistance.

RESULTS

A total of 1010 cases of blood culture-confirmed enteric fevers (S. typhi n=849; S. paratyphi A n=161) were recorded at the study hospital during the period from 2011-2020. Multidrug resistance among cases of S. typhi was 2.12 %, whereas it was completely absent among cases of S. paratyphi A. Fluoroquinolone resistance was high (>95%) throughout the study period. Resistance to ampicillin, chloramphenicol and co-trimoxacole was low (<3%) among S. typhi cases. No deaths were observed among study participants. Molecular docking analysis showed that quinolone had less binding affinity to mutated gyrase A than to its wild type for both S. typhi and S. paratyphi A.

CONCLUSION

Quinolone resistance was high among cases of enteric fever, whereas no resistance was observed among third-generation cephalosporins. In-silico studies indicated that a mutation in gyrase A might be the cause of the gradual increase in ciprofloxacin resistance over the study period.

Search for Neutrino-Induced Neutral-Current Δ Radiative Decay in MicroBooNE and a First Test of the MiniBooNE Low Energy Excess under a Single-Photon Hypothesis

We report results from a search for neutrino-induced neutral current (NC) resonant Δ(1232) baryon production followed by Δ radiative decay, with a ⟨0.8⟩  GeV neutrino beam. Data corresponding to MicroBooNE's first three years of operations (6.80×10^{20} protons on target) are used to select single-photon events with one or zero protons and without charged leptons in the final state (1γ1p and 1γ0p, respectively). The background is constrained via an in situ high-purity measurement of NC π^{0} events, made possible via dedicated 2γ1p and 2γ0p selections. A total of 16 and 153 events are observed for the 1γ1p and 1γ0p selections, respectively, compared to a constrained background prediction of 20.5±3.65(syst) and 145.1±13.8(syst) events. The data lead to a bound on an anomalous enhancement of the normalization of NC Δ radiative decay of less than 2.3 times the predicted nominal rate for this process at the 90% confidence level (C.L.). The measurement disfavors a candidate photon interpretation of the MiniBooNE low-energy excess as a factor of 3.18 times the nominal NC Δ radiative decay rate at the 94.8% C.L., in favor of the nominal prediction, and represents a greater than 50-fold improvement over the world's best limit on single-photon production in NC interactions in the sub-GeV neutrino energy range.

Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets

JUSTIFICATION

The emerging literature on prevalence of vitamin D deficiency in India, prevention and treatment strategies of rickets, and extra-skeletal benefits of vitamin D suggest the need for revising the existing guidelines for prevention and treatment of vitamin D deficiency in India.

OBJECTIVES

To review the emerging literature on vitamin D prevalence and need for universal vitamin D supplementation. To suggest optimum vitamin D therapy for treatment of asymptomatic and symptomatic vitamin D deficiency, and rickets. To evaluate the extra-skeletal health benefits of vitamin D in children.

PROCESS

A National consultative committee was formed that comprised of clinicians, epidemiologists, endocrinologists, and nutritionists. The Committee conducted deliberations on different aspects of vitamin D deficiency and rickets through ten online meetings between March and September, 2021. A draft guideline was formulated, which was reviewed and approved by all Committee members.

RECOMMENDATIONS

The group reiterates the serum 25-hydroxy vitamin D cutoffs proposed for vitamin D deficiency, insufficiency, and sufficiency as <12 ng/mL, 12-20 ng/mL and >20 ng/mL, respectively. Vitamin D toxicity is defined as serum 25OHD >100 ng/mL with hypercalcemia and/or hypercalciuria. Vitamin D supplementation in doses of 400 IU/day is recommended during infancy; however, the estimated average requirement in older children and adolescents (400-600 IU/day, respectively) should be met from diet and natural sources like sunlight. Rickets and vitamin D deficiency should be treated with oral cholecalciferol, preferably in a daily dosing schedule (2000 IU below 1 year of age and 3000 IU in older children) for 12 weeks. If compliance to daily dosing cannot be ensured, intermittent regimens may be prescribed for children above 6 months of age. Universal vitamin D supplementation is not recommended in childhood pneumonia, diarrhea, tuberculosis, HIV and non-infectious conditions like asthma, atopic dermatitis, and developmental disorders. Serum 25-hydroxy vitamin D level of >20 ng/mL should be maintained in children with conditions at high-risk for vitamin deficiency, like nephrotic syndrome, chronic liver disease, chronic renal failure, and intake of anticonvulsants or glucocorticoids.

Coronavirus Disease 2019 (COVID-19) Vaccination for Children: Position Statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices

JUSTIFICATION

Data generated after the first wave has revealed that some children with coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected Covid-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2-18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval.

OBJECTIVE

To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use.

PROCESS

Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of Covid-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on Covid-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized.

RECOMMENDATIONS

The IAP supports the Government of India's decision to extend the COVID-19 vaccination program to children between 2-18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out.

Disposable biosensors based on metal nanoparticles

The coronavirus disease2019 (COVID-19) pandemic has highlighted the need for disposable biosensors that can detect viruses in infected patients quickly due to fast response and also at a low cost.The present review provides an overview of the applications of disposable biosensors based on metal nanoparticles in enzymatic and non-enzymatic sensors with special reference to glucose and H₂O₂, immunosensors as well as genosensors (DNA biosensors in which the recognized event consists of the hybridization reaction)for point-of-care diagnostics. The disposable biosensors for COVID19 have also been discussed.

Age Structured Mathematical Modeling Studies on COVID-19 with respect to Combined Vaccination and Medical Treatment Strategies

In this study, we develop a mathematical model incorporating age-specific transmission dynamics of COVID-19 to evaluate the role of vaccination and treatment strategies in reducing the size of COVID-19 burden. Initially, we establish the positivity and boundedness of the solutions of the non controlled model and calculate the basic reproduction number and do the stability analysis. We then formulate an optimal control problem with vaccination and treatment as control variables and study the same. Pontryagin’s Minimum Principle is used to obtain the optimal vaccination and treatment rates. Optimal vaccination and treatment policies are analysed for different values of the weight constant associated with the cost of vaccination and different efficacy levels of vaccine. Findings from these suggested that the combined strategies (vaccination and treatment) worked best in minimizing the infection and disease induced mortality. In order to reduce COVID-19 infection and COVID-19 induced deaths to maximum, it was observed that optimal control strategy should be prioritized to the population with age greater than 40 years. Varying the cost of vaccination it was found that sufficient implementation of vaccines (more than 77 %) reduces the size of COVID-19 infections and number of deaths. The infection curves varying the efficacies of the vaccines against infection were also analysed and it was found that higher efficacy of the vaccine resulted in lesser number of infections and COVID induced deaths. The findings would help policymakers to plan effective strategies to contain the size of the COVID-19 pandemic.

Coronavirus Disease 2019 (COVID-19) Vaccination for Children: Position Statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices

Justification

Data generated after the first wave has revealed that some children with Coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected COVID-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2–18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval.

Objective

To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use.

Process

Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of COVID-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on COVID-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized.

Recommendations

The IAP supports the Government of India’s decision to extend the COVID-19 vaccination program to children between 2–18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out.

A rare case of duodenal inversum- A laparoscopically manageable entity

Duodenal inversum is a rare disease not frequently encountered in clinical practice. The diagnosis is usually made late due to its rarity. Many other causes of abdominal pain like ulcer disease, pancreatitis, malrotation are mostly thought of initially and the diagnosis is usually missed. Only a few cases of duodenal inversum present with outlet obstruction. Duodenojejunostomy is perhaps the ideal management for duodenal inversum if the patient presents with outlet obstruction. Our intention is to create awareness of such a rare disease with an available definitive treatment option in the form of minimally invasive surgery. One such case of a 31-year-old man is described that was successfully managed by laparoscopic duodenojejunostomy.

Search for a Higgs Portal Scalar Decaying to Electron-Positron Pairs in the MicroBooNE Detector

We present a search for the decays of a neutral scalar boson produced by kaons decaying at rest, in the context of the Higgs portal model, using the MicroBooNE detector. We analyze data triggered in time with the Fermilab NuMI neutrino beam spill, with an exposure of 1.93×10^{20} protons on target. We look for monoenergetic scalars that come from the direction of the NuMI hadron absorber, at a distance of 100 m from the detector, and decay to electron-positron pairs. We observe one candidate event, with a standard model background prediction of 1.9±0.8. We set an upper limit on the scalar-Higgs mixing angle of θ<(3.3-4.6)×10^{-4} at the 95% confidence level for scalar boson masses in the range (100-200)  MeV/c^{2}. We exclude, at the 95% confidence level, the remaining model parameters required to explain the central value of a possible excess of K_{L}^{0}→π^{0}νν[over ¯] decays reported by the KOTO collaboration. We also provide a model-independent limit on a new boson X produced in K→πX decays and decaying to e^{+}e^{-}.

Pediatric Craniospinal Irradiation - The implementation and Use of Normal Tissue Complication Probability in Comparing Photon versus Proton Planning

Purpose:

The preferred radiotherapy treatment for medulloblastoma is craniospinal irradiation (CSI). With the aim of developing the potential to reduce normal tissue dose and associated post-treatment complications with photon and proton radiotherapy techniques for CSI. This report aims to carefully compare and rank treatment planning and dosimetric outcomes for pediatric medulloblastoma patients using normal tissue complication probability (NTCP) formalism between photon (three-dimensional conformal radiotherapy, intensity-modulated radiotherapy [IMRT], volumetric-modulated arc therapy [VMAT], and HT) and proton CSI.

Methods and Materials:

The treatment data of eight pediatric patients who typically received CSI treatment were used in this study. The patients were 7 years of age on average, with ages ranging from 3 to 11 years. A prescription dose of 3600 cGy was delivered in 20 fractions by the established planning methods. The Niemierko's and Lyman–Kutcher–Burman models were followed to carefully estimate NTCP and compare different treatment plans.

Results:

The NTCP of VMAT plans in upper and middle thoracic volumes was relatively high compared to helical tomotherapy (HT) and pencil beam scanning (PBS) (all P < 0.05). PBS rather than IMRT and VMAT in the middle thoracic region (P < 0.06) could significantly reduce the NTCP of the heart. PBS significantly reduced NTCP of the lungs and liver (all P < 0.05).

Conclusion:

The NTCP and tumor control probability (TCP) model-based plan ranking along with dosimetric indices will help the clinical practitioner or medical physicists to choose the best treatment plan for each patient based on their anatomical or clinical challenges.

Low temperatures or high isolation delay increases the average COVID-19 infections in India : A Mathematical modeling approach

The dynamics of COVID-19 in India are captured using a set of delay differential equations by dividing a population into five compartments. The Positivity and Boundedness of the system is shown. The Existence and Uniqueness condition for the solution of system of equations is presented. The equilibrium points are calculated and stability analysis is performed. Sensitivity analysis is performed on the parameters of the model. Bifurcation analysis is performed and the critical delay is calculated. By formulating the spread parameter as a function of temperature, the impact of temperature on the population is studied. We concluded that with the decrease in temperature, the average infections in the population increases. In view of the coming winter season in India, there will be an increase in new infections. This model falls in line with the characteristics that increase in isolation delay increases average infections in the population.

Breastfeeding and Coronavirus Disease 2019 (COVID-19) Vaccination: Position Statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices

Justification

In India, till recently, breastfeeding women have been excluded from the coronavirus disease (COVID-19) vaccination program, rendering a significant population of the country, including frontline workers, ineligible to derive the benefits of the COVID-19 vaccine rollout.

Objective

The objective of this recommendation is production of an evidence-based document to guide the pediatricians to give advice to breastfeeding mothers regarding the safety of COVID-19 vaccines in lactating women.

Process

Formulation of key question was done under the chairmanship of president of the IAP. It was followed by review of literature regarding efficacy and safety of COVID-19 vaccines in breastfeeding women. The recommendations of other international and national professional bodies were also deliberated in detail. The available data was discussed in the ACVIP focused WhatsApp group. Opinion of all members was taken and the final document was prepared after achieving consensus.

Recommendations

The IAP/ACVIP recommends the administration of COVID-19 vaccines to all breastfeeding women. The IAP/ACVIP endorses the recent recommendation of the Government of India, to consider all breastfeeding women as eligible for COVID-19 vaccination.

Kikuchi-Fujimoto disease presenting in a patient with SARS-CoV-2: a case report

Background

We present a yet to be described association of SARS-CoV-2 infection with Kikuchi-Fujimoto disease.

Case presentation

A 32-year-old physician with history of SARS-CoV-2 infection presented to the emergency department with 2 weeks of fever, chills, and right sided cervical lymphadenopathy. He was treated empirically for presumed folliculitis with worsening of symptoms leading to repeat presentation to the emergency department.

Extensive workup was unrevealing of an infectious cause and needle biopsy of the lesion was unrevealing. An excisional lymph node biopsy revealed follicular hyperplasia with necrotic foci showing abundance of histiocytes at the edge of necrosis with CD8 predominance of T-cells. Final diagnosis was deemed to be Kikuchi-Fujimoto disease. Antibiotic therapy was discontinued, and the patient’s symptoms resolved with steroid therapy and expectant management.

Conclusions

This is the first report of a patient developing Kikuchi-Fujimoto disease following SARS-CoV-2 infection. Clinicians should be aware of Kikuchi-Fujimoto disease as a possibility when approaching patients with hyper-inflammatory states who present with cervical lymphadenopathy.

Breastfeeding and Coronavirus Disease 2019 (COVID-19) Vaccination: Position Statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices

JUSTIFICATION

In India, till recently, breastfeeding women have been excluded from the coronavirus disease (COVID-19) vaccination program, rendering a significant population of the country, including frontline workers, ineligible to derive the benefits of the COVID-19 vaccine rollout.

OBJECTIVE

The objective of this recommendation is production of an evidence-based document to guide the pediatricians to give advice to breastfeeding mothers regarding the safety of COVID-19 vaccines in lactating women.

PROCESS

Formulation of key question was done under the chairmanship of president of the IAP. It was followed by review of literature regarding efficacy and safety of COVID-19 vaccines in breastfeeding women. The recommendations of other international and national professional bodies were also deliberated in detail. The available data was discussed in the ACVIP focused WhatsApp group. Opinion of all members was taken and the final document was prepared after achieving consensus.

RECOMMENDATIONS

The IAP/ACVIP recommends the administration of COVID-19 vaccines to all breastfeeding women. The IAP/ACVIP endorses the recent recommendation of the Government of India, to consider all breastfeeding women as eligible for COVID-19 vaccination.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

Activity of novel lactone ketolide nafithromycin against multicentric invasive and non-invasive pneumococcal isolates collected in India

Background

India is among the nations reporting substantial healthcare burden linked to pneumococcal infections. Nafithromycin is a novel lactone ketolide antibiotic, which recently entered Phase 3 development in India for the indication of community-acquired bacterial pneumonia (CABP).

Objectives

To assess the in vitro activity of nafithromycin against serotyped invasive and non-invasive Streptococcus pneumoniae isolates, collected from nine medical centres across India.

Methods

A total of 534 isolates of S. pneumoniae were collected during 2015–20 and serotyped as per CDC protocol. A subset of erythromycin-non-susceptible S. pneumoniae (n = 200) was screened for the presence of erm(B) and mef(A/E) genes. A subset of MDR isolates (n = 54) were also subjected to MLST. The MICs of antibiotics were determined by the reference agar-dilution method (CLSI). Susceptibilities of the comparators were interpreted as per CLSI criteria.

Results

Fifty-nine distinct serotypes were identified among the 534 isolates. Among erythromycin-non-susceptible isolates, erm(B) and mef(A/E) genes were found in 49% and 59% strains respectively, while MLST showed clonal diversity. Azithromycin (67.6% non-susceptible) and clindamycin (31.8% non-susceptible) showed limited activity. Penicillin (for non-meningitis) or quinolone non-susceptibility was low (<11% and <6%, respectively). Nafithromycin showed potent activity with MIC₅₀ and MIC₉₀ of 0.015–0.03 and 0.06 mg/L, respectively, regardless of the macrolide resistance mechanisms.

Conclusions

Indian pneumococcal isolates show poor susceptibilities to macrolides, in concordance with the global trend. Nafithromycin overcomes erm as well as mef-mediated macrolide resistance mechanisms expressed individually or concurrently in S. pneumoniae. This study supports continued clinical development of nafithromycin for pneumococcal infections including CABP.