Complement lectin pathway activation is associated with COVID-19 disease severity, independent of MBL2 genotype subgroups

IntroductionWhile complement is a contributor to disease severity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, all three complement pathways might be activated by the virus. Lectin pathway activation occurs through different pattern recognition molecules, including mannan binding lectin (MBL), a protein shown to interact with SARS-CoV-2 proteins. However, the exact role of lectin pathway activation and its key pattern recognition molecule MBL in COVID-19 is still not fully understood.MethodsWe therefore investigated activation of the lectin pathway in two independent cohorts of SARS-CoV-2 infected patients, while also analysing MBL protein levels and potential effects of the six major single nucleotide polymorphisms (SNPs) found in the MBL2 gene on COVID-19 severity and outcome.ResultsWe show that the lectin pathway is activated in acute COVID-19, indicated by the correlation between complement activation product levels of the MASP-1/C1-INH complex (p=0.0011) and C4d (p<0.0001) and COVID-19 severity. Despite this, genetic variations in MBL2 are not associated with susceptibility to SARS-CoV-2 infection or disease outcomes such as mortality and the development of Long COVID.ConclusionIn conclusion, activation of the MBL-LP only plays a minor role in COVID-19 pathogenesis, since no clinically meaningful, consistent associations with disease outcomes were noted

Patient and Provider Satisfaction With Telemedicine in Otolaryngology

Objective The objective of this study is to evaluate patient and provider satisfaction with telemedicine encounters across 3 otolaryngology practices. Study Design Cross-sectional survey. Setting A military community hospital, an academic military hospital, and a nonmilitary academic center. Methods A telephone-based survey of patients undergoing telemedicine encounters for routine otolaryngology appointments was performed between April and July 2020. Patients were asked about their satisfaction, the factors affecting care, and demographic information. A provider survey was emailed to staff otolaryngologists. The survey asked about satisfaction, concerns for reimbursement or liability, encounters best suited for telemedicine, and demographic information. The results were analyzed with descriptive statistics and a multivariable logistic linear regression model to determine odds ratios. Results A total of 325 patients were surveyed, demonstrating high satisfaction with telemedicine (average score, 4.49 of 5 [best possible answer]). Patients perceived “no negative impact” or “minor negative impact” on the encounter due to the lack of a physical examination or face-to-face interaction (1.86 and 1.95 of 5, respectively). High satisfaction was consistent across groups for distance to travel, age, and reason for referral. A total of 25 providers were surveyed, with an average satisfaction score of 3.44 of 5. Providers reported “slight” to “somewhat” concern about reimbursement (40%) and liability (32%). Conclusion Given patients’ and providers’ levels of satisfaction, there is likely a role for telemedicine in otolaryngology practice that may benefit patient care independent of the COVID-19 pandemic

Predicting failure of detection of peritonsillar abscess with ultrasound in pediatric populations

PURPOSE: Some patients require additional imaging following ultrasound (US) to definitively diagnose a peritonsillar abscess (PTA), delaying intervention and disease resolution. We seek to evaluate patient characteristics which may predispose to a secondary imaging requirement to diagnose PTA, in order to better understand ultrasound limitations and predict who will require additional studies. MATERIALS AND METHODS: Retrospective chart review of patients with an US for suspected PTA between July 2017 and July 2020. Patient age, weight, and clinical characteristics, such as pain, trismus, and reduced neck range of motion (ROM) were collected. The need for additional imaging, subsequent surgical intervention, and hospital length of stay (LOS) were also recorded. RESULTS: Of 411 qualifying patients, 73 underwent additional imaging. Patients who required additional imaging were younger (9.8 vs 11.3 years, p = 0.026) and more likely to have decreased neck ROM (17.8 vs 5.3 %, p = 0.001). Surgical intervention was performed more commonly (27.4 vs 14.8 %, p = 0.015) and hospital LOS was longer (24.0 vs 5.0 h, p \u3c 0.001) in those with secondary imaging. CONCLUSIONS: Specific patient characteristics, such as younger age and decreased neck range of motion, are associated with a higher need for additional imaging. Additionally, the need for additional imaging is associated with a longer hospital LOS and increased likelihood of surgical intervention. Nearly 18 % of patients who underwent US evaluation of PTA required secondary imaging. Although transcervical US remains an excellent tool for diagnosing PTA, this data supports the utility of secondary imaging in certain instances

NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

Objective The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses. Methods A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator. Results Thirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days ( P = .027). Discussion The NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population. Implications for Practice: Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Search for the lepton-flavour violating decays B0→K∗0μ±e∓B^0 \to K^{*0} \mu^\pm e^\mp and Bs0→ϕμ±e∓B_s^0 \to \phi \mu^\pm e^\mp

A search for the lepton-flavour violating decays $B^0 \to K^{*0} \mu^\pm e^\mp$ and $B_s^0 \to \phi \mu^\pm e^\mp$ is presented, using proton-proton collision data collected by the LHCb detector at the LHC, corresponding to an integrated luminosity of $9\,\text{fb}^{-1}$. No significant signals are observed and upper limits of \begin{align} {\cal B}( B^0 \to K^{*0} \mu^+ e^- ) &< \phantom{1}5.7\times 10^{-9}~(6.9\times 10^{-9}),\newline {\cal B}( B^0 \to K^{*0} \mu^- e^+ ) &< \phantom{1}6.8\times 10^{-9}~(7.9\times 10^{-9}),\newline {\cal B}( B^0 \to K^{*0} \mu^\pm e^\mp ) &< 10.1\times 10^{-9}~(11.7\times 10^{-9}),\newline {\cal B}( B_s^0 \to \phi \mu^\pm e^\mp ) &< 16.0\times 10^{-9}~(19.8\times 10^{-9}) \end{align} are set at $90\%~(95\%)$ confidence level. These results constitute the world's most stringent limits to date, with the limit on the decay $B_s^0 \to \phi \mu^\pm e^\mp$ the first being set. In addition, limits are reported for scalar and left-handed lepton-flavour violating New Physics scenarios.A search for the lepton-flavour violating decays B$^{0}$ → K$^{*0}$μ$^{±}$e$^{∓}$ and ${B}_s^0$→ ϕμ$^{±}$e$^{∓}$ is presented, using proton-proton collision data collected by the LHCb detector at the LHC, corresponding to an integrated luminosity of 9 fb$^{−1}$. No significant signals are observed and upper limits of${\displaystyle \begin{array}{c}\mathcal{B}\left({B}^0\to {K}^{\ast 0}{\mu}^{+}{e}^{-}\right)<5.7\times {10}^{-9}\left(6.9\times {10}^{-9}\right),\\ {}\mathcal{B}\left({B}^0\to {K}^{\ast 0}{\mu}^{-}{e}^{+}\right)<6.8\times {10}^{-9}\left(7.9\times {10}^{-9}\right),\\ {}\mathcal{B}\left({B}^0\to {K}^{\ast 0}{\mu}^{\pm }{e}^{\mp}\right)<10.1\times {10}^{-9}\left(11.7\times {10}^{-9}\right),\\ {}\mathcal{B}\left({B}_s^0\to \phi {\mu}^{\pm }{e}^{\mp}\right)<16.0\times {10}^{-9}\left(19.8\times {10}^{-9}\right)\end{array}}$are set at 90% (95%) confidence level. These results constitute the world’s most stringent limits to date, with the limit on the decay ${B}_s^0$→ ϕμ$^{±}$e$^{∓}$ the first being set. In addition, limits are reported for scalar and left-handed lepton-flavour violating New Physics scenarios.[graphic not available: see fulltext]A search for the lepton-flavour violating decays $B^0 \to K^{*0} \mu^\pm e^\mp$ and $B_s^0 \to \phi \mu^\pm e^\mp$ is presented, using proton-proton collision data collected by the LHCb detector at the LHC, corresponding to an integrated luminosity of $9\,\text{fb}^{-1}$. No significant signals are observed and upper limits of \begin{align} {\cal B}( B^0 \to K^{*0} \mu^+ e^- ) &< \phantom{1}5.7\times 10^{-9}~(6.9\times 10^{-9}),\newline {\cal B}( B^0 \to K^{*0} \mu^- e^+ ) &< \phantom{1}6.8\times 10^{-9}~(7.9\times 10^{-9}),\newline {\cal B}( B^0 \to K^{*0} \mu^\pm e^\mp ) &< 10.1\times 10^{-9}~(11.7\times 10^{-9}),\newline {\cal B}( B_s^0 \to \phi \mu^\pm e^\mp ) &< 16.0\times 10^{-9}~(19.8\times 10^{-9}) \end{align} are set at $90\%~(95\%)$ confidence level. These results constitute the world's most stringent limits to date, with the limit on the decay $B_s^0 \to \phi \mu^\pm e^\mp$ the first being set. In addition, limits are reported for scalar and left-handed lepton-flavour violating New Physics scenarios

The LHCb upgrade I

International audienceThe LHCb upgrade represents a major change of the experiment. The detectors have been almost completely renewed to allow running at an instantaneous luminosity five times larger than that of the previous running periods. Readout of all detectors into an all-software trigger is central to the new design, facilitating the reconstruction of events at the maximum LHC interaction rate, and their selection in real time. The experiment's tracking system has been completely upgraded with a new pixel vertex detector, a silicon tracker upstream of the dipole magnet and three scintillating fibre tracking stations downstream of the magnet. The whole photon detection system of the RICH detectors has been renewed and the readout electronics of the calorimeter and muon systems have been fully overhauled. The first stage of the all-software trigger is implemented on a GPU farm. The output of the trigger provides a combination of totally reconstructed physics objects, such as tracks and vertices, ready for final analysis, and of entire events which need further offline reprocessing. This scheme required a complete revision of the computing model and rewriting of the experiment's software