Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy

PURPOSE

COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment.

MATERIALS AND METHODS

A retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria.

RESULTS

CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy.

CONCLUSIONS

CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.

Assessment of key characteristics, methodology, and effect size measures used in meta-analysis of human-health-related animal studies

Since the early 1990s the number of systematic reviews (SR) of animal studies has steadily increased. There is, however, little guidance on when and how to conduct a meta-analysis of human-health-related animal studies. To gain insight about the methods that are currently used we created an overview of the key characteristics of published meta-analyses of animal studies, with a focus on the choice of effect size measures. An additional goal was to learn about the rationale behind the meta-analysis methods used by the review authors. We show that important details of the meta-analyses are not fully described, only a fraction of all human-health-related meta-analyses provided rationales for their decision to use specific effect size measures. In addition, our data may suggest that authors make post-hoc decisions to switch to another effect size measure during the course of their meta-analysis, and possibly search for significant effects. Based on analyses in this paper we recommend that review teams: 1) publish a review protocol before starting the conduct of a SR, prespecifying all methodological details (providing special attention to the planned meta-analysis including the effect size measure and the rational behind choosing a specific effect size, prespecifying subgroups and restricting the number of subgroup analyses), 2) always use the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist to report your SR of animal studies, and 3) use the random effects model (REM) in human-health-related meta-analysis of animal studies, unless the assumptions for using the fixed effect model (FEM) are all met.

Multinational Observational Cohort Study of COVID-19-Associated Pulmonary Aspergillosis1

We performed an observational study to investigate intensive care unit incidence, risk factors, and outcomes of coronavirus disease-associated pulmonary aspergillosis (CAPA). We found 10%-15% CAPA incidence among 823 patients in 2 cohorts. Several factors were independently associated with CAPA in 1 cohort and mortality rates were 43%-52%.

The effect of analgesics on stimulus evoked pain-like behaviour in animal models for chemotherapy induced peripheral neuropathy- a meta-analysis

Chemotherapy induced painful peripheral neuropathy (CIPN) is a common dose-limiting side effect of several chemotherapeutic agents. Despite large amounts of human and animal studies, there is no sufficiently effective pharmacological treatment for CIPN. Although reducing pain is often a focus of CIPN treatment, remarkably few analgesics have been tested for this indication in clinical trials. We conducted a systematic review and meta-analyses regarding the effects of analgesics on stimulus evoked pain-like behaviour during CIPN in animal models. This will form a scientific basis for the development of prospective human clinical trials. A comprehensive search identified forty-six studies. Risk of bias (RoB) analyses revealed that the design and conduct of the included experiments were poorly reported, and therefore RoB was unclear in most studies. Meta-analyses showed that administration of analgesics significantly increases pain threshold for mechanical (SMD: 1.68 [1.41; 1.82]) and cold (SMD: 1. 41 [0.99; 1.83]) evoked pain. Subgroup analyses revealed that dexmedetomidine, celecoxib, fentanyl, morphine, oxycodone and tramadol increased the pain threshold for mechanically evoked pain, and lidocaine and morphine for cold evoked pain. Altogether, this meta-analysis shows that there is ground to investigate the use of morphine in clinical trials. Lidocaine, dexmedetomidine, celecoxib, fentanyl, oxycodone and tramadol might be good alternatives, but more animal-based research is necessary.

A systematic summary and comparison of animal models for chemotherapy induced (peripheral) neuropathy (CIPN)

Despite the large amount of human and experimental studies no effective (prophylactic) treatment exists for chemotherapy induced peripheral neuropathy (CIPN), a disabling side effect of many cancer treatments. One of the underlying reasons for this could be that often the preclinical animal models used are not the best representation of the clinical situation. We therefore present a systematic summary and comparison of all animal models currently described in literature for CIPN focusing on stimulus evoked pain-like behaviour and neurophysiological alterations in nerve function (650 included papers, and a comparison of 183 models), that resulted in a clear overview of the most effective and robust CIPN models using an administration route used in clinical practice. Using our three-step approach (step 1: efficacy; step; 2 robustness and step 3: mimicking the clinical situation) we show that all mice CIPN models treated with either paclitaxel or cisplatin using an administration route used in clinical practice seem suitable models. Three specific models using paclitaxel or cisplatin that stand out are 1) C57BL/6 female mice receiving paclitaxel and 2) CD1 male mice receiving paclitaxel and 3) C57BL/6 male mice receiving cisplatin. This overview may help scientists selecting suitable CIPN models for their research. We hypothesize that by using effective and robust animal models that mimic the clinical situation as much as possible, the translational value of preclinical study results with respect to the potential of identifying promising treatments for CIPN in the future, will prove. The methodology described in this paper, aimed at comparing animal models, is novel and can be used by scientist in other research fields as well.

Prolonged Duration of Brain Death was Associated with Better Kidney Allograft Function and Survival: A Prospective Cohort Analysis

BACKGROUND Brain death initiates hemodynamic, immunological, and hormonal changes that potentially compromise organ quality for transplantation. Therefore, it is generally believed that organs should be procured as soon as possible after the declaration of brain death. However, conflicting data exist regarding the impact of brain death duration on long-term graft function and survival. MATERIAL AND METHODS The effect of duration of brain death on graft survival and function of 1869 adult transplant recipients receiving kidneys from deceased donors after brain death was analyzed, using relevant donor and recipient characteristics and allograft related factors. RESULTS Duration of brain death was a significant predictor for long-term graft survival, whilst there was no significant effect of duration of brain death on the incidence of delayed graft function or acute graft rejection after kidney transplantation. After dividing the study population into a "short durBD" (<10.6 hours) group and a "long durBD" (>10.6 hours) group, the 15-year graft survival estimates were significantly higher and the serum creatinine at 3 months after transplantation was significantly lower in the "long durBD" group. CONCLUSIONS Duration of brain death does not affect the incidence of delayed graft function or acute rejection after kidney transplantation. However, longer duration of brain death is associated with better kidney allograft function and survival.

Protective effect of curcumin on priapism and ischemia-reperfusion injury in rats

OBJECTIVE

We aimed to identify the oxidative stress effects of the ischemic priapism on cavernosal tissues and to assess the biochemical and histopathological effects of curcumin in rats.

MATERIALS AND METHODS

26 adult male Sprague Dawley rats were randomly divided into three groups. Group 1 (Control, n = 8): only penectomy was performed and 3 ml blood samples were obtained from the vena cava inferior (VCI). Group 2 (ischemia-reperfusion group; n= 8): penectomy was performed after 1 hour ischemic priapism + 30 min reperfusion and 3 ml blood samples were obtained from the VCI. Group III (IR + CURC group, n = 10): 200 mg/kg/day curcumin per orally before surgery for 7 days + penectomy after 1 hour ischemic priapism + 30 min reperfusion and 3 ml blood samples from the VCI. Total oxidant status (TAS), total antioxidant status (TAS) and paraoxonase (PON1) levels were measured. Tissue samples were investigated and scored histopathologically in terms of bleeding, edema and necrosis.

RESULTS

TOS levels were higher (p = 0.002), and TAS levels were lower (p = 0.001) in the IR group compared to the control group. As a result of curcumin treatment, TAS levels were increased (p = 0.003), and TOS levels were decreased (p = 0.004) in the IR + CURC group compared to the IR group. In the treatment group (IR + CURC) TAS and TOS levels were similar to levels in the control group. PON1 levels were increased with ischemia-reperfusion (p = 0.21) and decreased with curcumin treatment (p = 0.53), however these changes were not statistically significant. There was no significant difference in the effects of curcumin on histopathological changes.

CONCLUSIONS

This study showed that curcumin has preventive effects on oxidative stress parameters against ischemia-reperfusion injury.

TEI Index in elite sprinters and endurance athletes

AIM

Aerobic training has been reported to have a positive effect on myocardial performance index. The aim of the present study was to examine the myocardial performance index (MPI) in sprinters and endurance athletes.

METHODS

A total of 66 elite male athletes (36 sprinter and 30 endurance athletes) and 33 agematched sedentary controls voluntarily participated in the study. The echocardiographic evaluation was performed and TEI index was measured as a marker of myocardial performance index in all groups.

RESULTS

Demographic features, training ages and weekly exercise volumes were similar in sprinters and endurance athletes. There were no significant differences in terms of diastolic parameters and among the groups. In sprinters, isovolumetric relaxation time (IVRT) and isovolumetric contraction time (IVCT) were significantly shorter than in controls. In endurance athletes, IVCT was significantly shorter than in controls. Both sprinters and endurance athletes had longer ET compared with controls. TEI Index was significantly lower in sprinters and endurance athletes than in controls.

CONCLUSION

Our results suggest that both aerobic and anaerobic training seem to have a positive effect on myocardial performance. This comparable effect might be a result of frequently exercising, especially aerobic exercising in sprinters' training programs.

A cross-sectional analysis of sagittal knee laxity and isokinetic muscle strength in soccer players

In this cross-sectional study, sagittal knee laxity and isokinetic strength of knee extensor and flexor muscle groups were measured and differences related to leg dominance were evaluated. A total of 44 healthy male soccer players (who had trained regularly at least for the last five years) and 44 sedentary people as their control counterparts were involved in this study. All participants were tested using a KT-1000 knee arthrometer for knee laxity. Isokinetic concentric knee peak torque and hamstring/quadriceps (H/Q) ratio were also measured at 60, 180, 300 degrees/s through a Cybex 2 - 340 dynamometer. Posterior laxity in the non-dominant side of soccer players was significantly higher than in the dominant side (p < 0.005) while there were no significant anterior and total anteroposterior (total AP) laxity differences in both groups. Soccer players had significantly lower anterior and total AP laxity values than controls (p < 0.0001) while there was no significant difference between posterior laxity values in both sides. Dominant extremity demonstrated significantly higher knee flexor peak torque and H/Q ratio at 180 degrees /s in soccer players (p < 0.05). Similarly in sedentary controls, H/Q ratio at 60 degrees /s of the dominant side was significantly higher than that in the non-dominant side (p < 0.05). Soccer players had significantly higher extensor and flexor peak torque values and H/Q ratios than sedentary subjects for both extremities. In both groups, there were no significant correlations between knee laxity and isokinetic knee extensor and flexor strength and H/Q ratios except weak negative correlation between posterior knee laxity and isokinetic extensor peak torque at 60, 180 and 300 degrees /s (p < 0.005, r = - 0.43, p < 0.05, r = - 0.39, p < 0.05, r = - 0.32 respectively) in the non-dominant side of soccer players and at 300 degrees /s (p < 0.05, r = - 0.32) in the non-dominant side of controls. Soccer players demonstrated significantly less sagittal knee laxity and higher isokinetic strength of the knee flexors and extensors compared to sedentary controls. Isokinetic strength difference was found to be higher for the flexor muscle group. Further prospective studies are needed to explain whether the increased H/Q ratio decreases the risk of ligamentous injury.