Epidemiologic disparities in colon cancer screening and adherence during the COVID-19 pandemic: a retrospective cohort analysis

BACKGROUND

Colorectal cancer (CRC) is the second-leading cause of death in the USA. CRC screening remains underutilized, especially in underinsured populations. Screening has been heavily disrupted during the COVID-19 pandemic.

PURPOSE

The goal is to explore the impact of the pandemic on ethnic and gender disparities in CRC screening.

METHODS

Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020, as the inflection point. The primary inclusion criterion was an ordered colonoscopy. The outcome of interest was a colonoscopy performed. Differences by year and race were assessed using chi-square analysis. A cohort of 1549 patients (899 in pre-COVID; 650 in post-COVID) between age 45 and 75 for whom a colonoscopy was ordered was selected from EHR at a large institution.

RESULTS

There was a 51% reduction in screening colonoscopies performed. White patients had a decrease of 49%, and African Americans had a 55% reduction. Stool testing increased from 47% prior to the pandemic to 94% during the pandemic representing a greater than 100% increase in stool testing uptake.

CONCLUSION

The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to the widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our study points to the drastic reduction of screening for all races, especially for African Americans.

Fungal contamination of nebuliser devices used by people with cystic fibrosis

BACKGROUND

Poor nebuliser hygiene can result in bacterial contamination and risk of infections. The aim of this study was to assess the prevalence of fungal contamination of nebulisers used by adults with cystic fibrosis.

METHODS

A total of 170 nebulisers from 149 subjects were screened by wetting a sterile cotton swab with sterile water and swabbing each drug chamber. The swab was then plated out on Sabouraud and on Scel+agar and incubated at 27 °C for up to 2 weeks.

RESULTS

Fungal cultures were positive in 86 (57.7%) patient's devices. In 28/149 (18.8%), 39/149 (26.2%), 47/149 (31.5%) and 20/149 (13.4%) of subjects Aspergillus species, yeasts, moulds and both yeasts and moulds were isolated respectively. There was no difference in contamination rates between different devices.

CONCLUSION

Nebuliser devices are frequently contaminated by moulds and yeasts and emphasis should be placed on ensuring adequate nebuliser hygiene.

Nutritional decline in cystic fibrosis related diabetes: the effect of intensive nutritional intervention

BACKGROUND

Reports indicate that nutritional and respiratory decline occur up to four years prior to diagnosis of cystic fibrosis related diabetes (CFRD). Our aim was to establish whether intensive nutritional intervention prevents pre-diabetic nutritional decline in an adult population with CFRD.

METHODS

48 adult patients with CFRD were matched to 48 controls with CF, for age, gender and lung pathogen status. Nutritional and other clinical indices were recorded at annual intervals from six years before until two years after diagnosis. Data were also analysed to examine the impact of early and late acquisition of CFRD.

RESULTS

No important differences in weight, height, body mass index (BMI), lung function or intravenous treatment were found between groups in the six years prior to diagnosis, nor any significant deviation over time. In those who developed diabetes, use of overnight enteral tube feeding (ETF) was four times as likely at the time of diagnosis, compared to controls [ETF 43.8% (CFRD) v 18.8% (CF Controls), OR 4.0, CI 1.3 to 16.4, p=0.01]. Age at onset of CFRD played a significant role in determining the pre-diabetic clinical course. Younger diabetics with continued growth at study onset (n=17) had a lower BMI from 2 years prior to diagnosis compared to controls [BMI 18.9 kg/m(2) (CFRD) v 20.8 kg/m(2) (CF Controls), diff=1.9, CI -0.1 to 3.7 p=0.04]. The BMI of older diabetics (completed growth at study onset) was equal to that of controls throughout.

CONCLUSION

Pre-diabetic nutritional decline is not inevitable in adults with CFRD, but is influenced by age of onset. In the group overall, those with CFRD are more likely to require ETF from 2 years prior to diagnosis. Despite intensive nutritional intervention, patients who continue to grow throughout the pre-diabetic years, show a level of nutritional decline absent in older adults.

Discovery of a cool planet of 5.5 Earth masses through gravitational microlensing

In the favoured core-accretion model of formation of planetary systems, solid planetesimals accumulate to build up planetary cores, which then accrete nebular gas if they are sufficiently massive. Around M-dwarf stars (the most common stars in our Galaxy), this model favours the formation of Earth-mass (M(o)) to Neptune-mass planets with orbital radii of 1 to 10 astronomical units (au), which is consistent with the small number of gas giant planets known to orbit M-dwarf host stars. More than 170 extrasolar planets have been discovered with a wide range of masses and orbital periods, but planets of Neptune's mass or less have not hitherto been detected at separations of more than 0.15 au from normal stars. Here we report the discovery of a 5.5(+5.5)(-2.7) M(o) planetary companion at a separation of 2.6+1.5-0.6 au from a 0.22+0.21-0.11 M(o) M-dwarf star, where M(o) refers to a solar mass. (We propose to name it OGLE-2005-BLG-390Lb, indicating a planetary mass companion to the lens star of the microlensing event.) The mass is lower than that of GJ876d (ref. 5), although the error bars overlap. Our detection suggests that such cool, sub-Neptune-mass planets may be more common than gas giant planets, as predicted by the core accretion theory.

Predictors of desaturation during formal hypoxic challenge in adult patients with cystic fibrosis

Assessment of the potential risk of in flight hypoxaemia in patients with cystic fibrosis is often based on a hypoxic challenge where individuals have saturations and/or blood gases taken before and after inspiring 15% normobaric oxygen. The aim of this study was to see if routine clinical measurements could predict the outcome of this test. This was a prospective study comparing the modified 6-min walking test, lung function, body mass index, Northern (N) and Shwachman-Kulczycki (SK) scores with a hypoxic challenge (flight test) in 69 adults attending the Leeds regional CF Unit. Although, there was a significant correlation between post flight test PaO(2) and N score (P=0.003), SK score (P=0.002), FVC % predicted (P=0.01), FEV(1) % predicted (P=0.002), resting saturations (P<0.001), 6 min saturation on walking test (P<0.001) and baseline PaO(2) (P<0.001), no single parameter could accurately predict all patients who desaturated during the flight test. No individual clinical parameter appears to fully predict the need for in flight oxygen but patients most at risk appear to have either a low FEV(1) (<60%), high N score (>13) or low baseline PaO(2) (<10.5 kPa).

Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis

There is circumstantial evidence that nebulizer equipment may be a source of Stenotrophomonas maltophilia for patients with cystic fibrosis. Eighty-nine inpatient nebulizers were examined for evidence of S. maltophilia contamination of which nine (10%) yielded 14 strains of the bacterium. Environmental samples were obtained from 73 different sites on the ward, of which 17 (23%) yielded a further 21 strains. Positive sites included taps, sink drains, and potable water. Genotyping using ERIC-PCR and pulsed-field gel electrophoresis revealed that two pairs of patients' nebulizers were contaminated with closely related strains. None of the S. maltophilia isolates obtained from the ward environment shared genotypes with those obtained from the nebulizers. The frequency of isolation of S. maltophilia from potable water sources on the ward suggests that contamination may result from using it to clean reusable nebulizer equipment, particularly if this is followed by inadequate drying. Although the actual source of S. maltophilia contamination of hospital-use nebulizer equipment in this study remained elusive, these results have important infection control implications.

Travis and Arms revisited: a second look at a widely used bioconcentration algorithm

In 1988, Travis and Arms reviewed the literature and collected data to develop a relationship between the octanol-water partition coefficient (Kow) and the uptake of organic compounds into milk and beef (Travis and Arms, 1988). These equations have been utilized for predicting biotransfer factors for organic chemicals when empirical data are lacking. During the external peer review of the draft US Environmental Protection Agency (EPA) guidance entitled Human Health Risk Assessment Protocol for Hazardous Waste Combustion Facilities (US EPA, 1998) and the development of Superfund's Ecological Soil Screening Levels (US EPA, 2000b), questions challenging the derivation and use of these equations were raised. The primary questions raised were: 1) Are the equations presented in Travis and Arms (1988) for the estimation of transfer of organic compounds from contaminated feed to beef and milk technically valid and reproducible? If so, (2) are the equations appropriate across the entire log Kow range? For these reasons, this study was undertaken to validate the original Travis and Arms equations, to review more recent literature, and. if appropriate, to add to the original Travis and Arms data set to obtain updated equations. This paper presents an evaluation of the original Travis and Arms equations, limitations to their use, and steps to reduce uncertainties associated with their use by updating with more current literature.

International Child Care Practices Study: infant sleeping environment

BACKGROUND

The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature.

METHODS

Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to "reduce the risks of SIDS" were available at the time of the survey.

RESULTS

Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2-88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58-100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%.

CONCLUSIONS

It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of "typical" bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

Night-time non-nutritive sucking in infants aged 1 to 5 months: relationship with infant state, breastfeeding, and bed-sharing versus room-sharing

AIM

Epidemiological studies suggest that pacifier use may be protective against SIDS but little is known of the relationship between pacifier use and other forms of non-nutritive sucking (NNS) in infancy, or of patterns of NNS during the night, when most SIDS deaths occur. We report the first longitudinal study of NNS by direct overnight observations in healthy infants in a sleep laboratory.

METHODS

Healthy, breast fed term infants (n = 10) were enrolled at birth, and sequential overnight polygraphic and infrared video recordings of infants with their mothers performed at monthly intervals from 1 to 5 months. Each month, mother baby pairs were randomized to 1 night bed-sharing (BN) then 1 room-sharing (RN), or vice versa. 'Episodes' of pacifier, own digit and mother's digit sucking (> 1 min) were identified and compared with state-matched control periods without sucking or feeding before and after each such episode.

RESULTS

329 episodes of NNS were identified in 749 h of video recording. The prevalence of pacifier sucking decreased with age, whilst digit sucking increased. Routine pacifier users rarely sucked their digits. There were temporal differences throughout the night in the distribution of different types of sucking and in infant state during and around sucking episodes. Sleeping in the 'non-routine' location was associated with a larger percentage of nights with sucking episodes and increased sleep latency. Bed sharing (routinely or on a given night) was associated with less sucking behavior and more breastfeeding. Non-nutritive sucking was not, however, associated with decreased total time breastfeeding per night or number of feeds per night.

CONCLUSION

Patterns of NNS during the night change with age and are affected by maternal proximity. Digit sucking has state modulating effects, and may be suppressed by pacifier use. Thus any benefits of pacifier use must be set against the potential loss of a self-directed ability to modulate state during the night, and possible shortening of breastfeeding duration.

Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. CESDI SUDI Research Team

OBJECTIVES

To investigate the relation between pacifier use and sudden infant death syndrome (SIDS).

DESIGN

Three year population based, case control study with parental interviews for each death and four age matched controls.

SETTING

Five regions in England (population > 17 million).

SUBJECTS

325 infants who had died from SIDS and 1300 control infants.

RESULTS

Significantly fewer SIDS infants (40%) than controls (51%) used a pacifier for the last/reference sleep (univariate odds ratio (OR), 0.62; 95% confidence interval (CI), 0.46 to 0.83) and the difference increased when controlled for other factors (multivariate OR, 0.41; 95% CI, 0. 22 to 0.77). However, the proportion of infants who had ever used a pacifier for day (66% SIDS v 66% controls) or night sleeps (61% SIDS v 61% controls) was identical. The association of a risk for SIDS infants who routinely used a pacifier but did not do so for the last sleep became non-significant when controlled for socioeconomic status (bivariate OR, 1.39 (0.93 to 2.07)).

CONCLUSIONS

Further epidemiological evidence and physiological studies are needed before pacifier use can be recommended as a measure to reduce the risk of SIDS.

Daytime melatonin administration in elderly good and poor sleepers: effects on core body temperature and sleep latency

Melatonin has been shown to have hypnotic and hypothermic effects in young adults and has been proposed as treatment for insomnia. However, the hypnotic and thermoregulatory effects of melatonin remain to be simultaneously investigated for aged good and poor sleepers. The aim of this study was to explore the short-term effects of exogenous oral daytime melatonin on core body temperature, sleep latency, and subjective vigor and affect in aged women. Twelve sleep maintenance insomniacs and 10 good sleeping postmenopausal female subjects [mean (SD) age = 65.2 (7.4) years] participated in a double-blind, crossover study in which they received a capsule containing either melatonin (5 mg) or a placebo at 1400 hours. Continuous core body temperature and hourly multiple sleep latency tests (MSLT) were collected from 1100-2030 hours. Self-reported estimates of global vigor (sleepiness) and affect were collected prior to each MSLT using visual analog scales. Comparison of good and poor sleepers failed to reveal any significant differences in core body temperature, sleep latency, or subjective vigor and affect. However, for both groups combined, melatonin administration [absolute postadministration mean (SEM) = 36.9 (0.05) degrees C] significantly lowered core body temperature compared with placebo [37.1 (0.05) degrees C]. Similarly, melatonin administration significantly reduced latency to stage 1 (SOL1) and stage 2 (SOL2) [absolute postadministration mean SOL1 = 20.1 (1.7) and SOL2 = 20.7 (1.6) minutes] compared with placebo [SOL1 = 24.3 (1.2) and SOL2 = 25.2 (1.1) minutes]. Treatment had no significant effect on either vigor or affect. Overall, our results suggest that although short-term exogenous oral daytime melatonin has significant hypothermic and hypnotic effects in aged women, the size of the effects is modest.

Placental chorioangioma: a case report and literature review

We report on a large asymptomatic placental chorioangioma, identified as an area of reduced echogenicity on ultrasound at 36 weeks' gestation. Despite the large size, it was not associated with the usual maternal or fetal complications expected with a chorioangioma of that size, possibly because of thrombosis and tumour degeneration.

Primary malignant melanoma of the uterine cervix

A case of primary malignant melanoma of the uterine cervix is presented. It demonstrates the histological findings at both light and electron microscopy, the unusual flow cytofluorometric analysis, the clinical response to irradiation and the rapid dissemination of the tumour.

Multiple peptide production and presence of general neuroendocrine markers detected in 12 cases of human phaeochromocytoma and in mammalian adrenal glands

In this study, antibodies to a range of markers of neuroendocrine differentiation were evaluated for their use in the histopathological assessment and characterisation of phaeochromocytomas. Routinely processed wax blocks from eleven adrenal phaeochromocytomas (10 benign and 1 malignant) and one benign phaeochromocytoma of the urinary bladder were investigated. In addition to these tumours, normal human, cat and piglet adrenal glands were examined. In the phaeochromocytomas, immunostaining was obtained with 21 of the 25 antisera used. Of the general neuroendocrine markers, neuron-specific enolase was found in all tumours, and chromogranin and protein gene-product 9.5 in most of the cases. A range of regulatory peptide immunoreactivities could be demonstrated, such as enkephalin, neuropeptide tyrosine (NPY), 7B2, galanin and vasoactive intestinal polypeptide (VIP). In addition, two peptides were found which have not been reported previously in these tumours, peptide histidine methionine (PHM) and the cryptic fragment of the precursor encoding VIP. Co-localisation studies revealed that peptides derived from the same precursor or peptide family were found in the same tumour cells (e.g. VIP and PHM, NPY and its C-flanking peptide CPON). In the normal adrenal medulla, all the peptides previously reported to be present could be demonstrated immunocytochemically. Galanin was present in a subpopulation of cells also immunoreactive for enkephalin. Neuropeptide tyrosine and CPON were demonstrated in another subpopulation. Occasionally, cells were found to contain all four antigen immunoreactivities. Using antisera to enzymes involved in catecholamine synthesis, galanin was found to be present in noradrenaline-containing cells. The study demonstrates the presence of various antigens in chromaffin tissue of the adrenal gland. A range of substances can also be identified immunocytochemically in phaeochromocytoma tissue, using routinely-processed material.

Adrenal cysts--report, review and classification

A case of a giant adrenal pseudocyst is reported. The clinico-pathological features are reviewed and a classification is proposed.

Fixation, processing, and immunochemical reagent effects on preservation of T-lymphocyte surface membrane antigens in paraffin-embedded tissue

Fixatives, fixation additives, paraffin processing reagents, and immunochemical reagents were investigated for effects on preservation of T-lymphocyte surface membrane antigens CD3, CD4, and CD8 in human tonsil. Individual reagent effects were assessed in frozen sections by use of monoclonal antibodies and this information was used to optimize T-cell immunostaining in paraffin sections. Harmful factors were fixation delay, fixation at acid pH, fixation and processing at temperatures above 4 degrees C, hot paraffin wax, proteolytic enzymes, methanolic hydrogen peroxide, Triton X-100, and prolonged iodine treatment. Optimal T-cell demonstration in paraffin sections followed tissue fixation in periodate-lysine-paraformaldehyde dichromate at 4 degrees C, pH 7.5; processing through isopropanol, then xylene or chloroform, at 4 degrees C; and embedding in low melting point wax at 45-50 degrees C. Graded antigen stability occurred: CD3 most stable, CD8 least, and CD4 intermediate. CD4 and CD8 antigen preservation in paraffin sections required critical optimal tissue handling. CD3 was more stable and was also demonstrated in tissue fixed in commercial formalin, glutaraldehyde, and Bouin's fluid when fixation and processing conditions were optimized for pH and temperature. Of the fixation additives studied, polyethylene glycol and several potassium and magnesium salts enhanced immunostaining, whereas calcium chloride and lidocaine were deleterious.

A case of nasal glioma and neurofibromatosis. A new association

A man of 25 with von Recklinghausen's neurofibromatosis (VR) developed nasal polyps. Subarachnoid haemorrhage occurred shortly after surgical excision and he died 9 weeks later. Post-mortem examination showed chronic hydrocephalus due to aqueduct stenosis. Histologically the polyps were a nasal glioma, a forme fruste of anterior encephalocoele not previously associated with VR, though other cranial defects are well recognized. Nasal glioma should be considered in the differential diagnosis of nasal lesions in VR.

Effect fixation on T and B lymphocyte surface membrane antigen demonstration in paraffin processed tissue

The identification of lymphoid surface membrane antigens in tissue sections using immunohistochemical techniques is becoming increasingly important for the diagnosis and classification of lymphoproliferative disorders. Many of the lymphocyte specific monoclonal antibodies used, however, can only be applied to frozen tissue sections. In this paper we report the successful application of a number of these antibodies to paraffin processed tissue utilizing alternative fixatives and the highly sensitive immunogold-silver staining method. The best fixatives for this purpose were formol dichromate, periodate-lysine-paraformaldehyde (PLP) and a novel fixative formed from the addition of a dichromate solution to PLP.

T cell-specific human alloantisera-detecting antigens segregating outside the major histocompatibility complex

Two sera demonstrated non-HLA lymphocytotoxicity on the basis of reactivity with the cells of siblings genotypically identical to the serum donors for the major histocompatibility complex. These two sera, Bl and Caf, once contaminating HLA antibodies were removed by absorption with pooled platelets, demonstrated allogeneic lymphocytotoxicity that was restricted to T lymphocytes. Reactivity of the absorbed sera segregated independently of the major histocompatibility complex in 3 of 12 families tested. Unlike both cold lymphotoxins and HLA antibodies, the absorbed sera showed little temperature sensitivity against allogeneic cells, although reactivity of the Bl serum to autologous cells and to cells of the donor's HLA identical sibling did show a decrease with increasing temperature and restriction of activity to the 19S-containing fraction. Granulocytes were unreactive with the absorbed sera. Such sera may provide probes of minor transplantation antigens or markers, or both, of lymphoid subpopulations.