bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of clinical examination of the optic nerve head in glaucoma today
Authors: Sihota Ramanjit , Sidhu Talvir , Dada Tanuj
Published: January 2021

Purpose of review

The study was undertaken to assess the current importance of clinical examination of the optic nerve head (ONH) in glaucoma management.

Recent findings

ONH changes in glaucoma are easily assessed with good specificity on examination, whereas imaging has not been able to identify pallor of the neuroretinal rim (NRR), disc hemorrhages, or vascular signs of acquired cupping. Glaucomatous neuropathy in primary open angle glaucoma (POAG) has extensive databases on imaging machines, however, other glaucomas such as primary angle closure glaucoma (PACG), juvenile open angle glaucoma (JOAG), congenital, and secondary glaucomas have been reported to have a significantly different ONH morphology. Clinical evaluation with knowledge of the underlying cause of glaucoma allows easy diagnosis of any abnormality, whereas the absence of an imaging database in such eyes makes diagnosis difficult on optical coherence tomography (OCT) and so forth. In eyes with congenital anomalies and dysplastic discs, clinical examination and history provide better identification of glaucomatous damage. Staging of glaucoma on ONH examination when perimetry is unreliable provides a means of determining the amount of damage and appropriate reduction of intraocular pressure (IOP).

Clinical examination of the ONH is very relevant for screening, diagnosis, staging, and management of all glaucomas, and is irreplaceable in detecting nonglaucomatous causes of ONH cupping and visual field defects similar to those in glaucoma.
The Outcome of Accidental Bacille Calmette-Guérin Overdose During Routine Neonatal Immunization
Authors: Greybe Leonore , Morrison July L. , Schaaf H. Simon , Rabie Helena , Cotton Mark F.
Published: January 2021

We report a retrospective study on outcome of 14 newborn infants who received 62.5 times the recommended dose of Bacille Calmette-Guérin for immunization. All infants then received high-dose isoniazid and rifampicin (20 mg/kg/d each) as preventive therapy for 6 months. All had mild local adverse reactions, a third resolving within 16 weeks and all by 6 months.
COVID-19–Associated Eosinopenia in a Patient With Chronic Eosinophilia Due to Chronic Strongyloidiasis
Authors: Stylemans Dimitri , Van Cauwelaert Stefan , D'Haenens Alexander , Slabbynck Hans
Published: January 2021

Eosinopenia was frequently encountered in patients with coronavirus disease 2019 (COVID-19). We describe a case of a 59-year-old man who was treated with high-dose corticosteroids and anti-interleukin 1 receptor antagonist therapy because of severe acute respiratory distress syndrome due to a so-called cytokine storm in COVID-19. He had chronic eosinophilia for many years due to an unknown Strongyloides stercoralis infection, proven by serology and a positive polymerase chain reaction test on a stool sample. COVID-19 led to a complete resolution of eosinophilia, even before immunosuppressive treatment was started. Eosinophilia returned after recovery from COVID-19 and started to decline under treatment with ivermectin. Our case confirms previous reports of eosinopenia in COVID-19, as it appears even in patients with chronic eosinophilia. Presence of eosinophilia should prompt screening for strongyloidiasis in all patients eligible for immunosuppressive therapy because of the risk of Strongyloides hyperinfection syndrome, especially if this treatment is empirical.
Ab externo approach to treat bilateral haptic extrusion secondary to scleral erosion of an intrascleral sutureless-fixated intraocular lens
Authors: Jürgens Ignasi , Pighin María S.
Published: January 2021

Surgical management of haptic extrusion of an intrascleral sutureless-fixated intraocular lens (IOL) (FIL-SSF Carlevale, Soleko) by repositioning the IOL without lens extraction was reported. The patient presented an early extrusion of both IOL harpoons just 4 weeks after the initial surgery. New scleral flaps were created 30 degrees superior to the nasal harpoon and 30 degrees inferior to the temporal harpoon so that the IOL was rotated clockwise. Each haptic was grasped with a 25-gauge forceps and introduced into the vitreous cavity and regrasped with another forceps through a new port, 1.5 mm posterior to the limbus, and underneath a new scleral flap. The Carlevale IOL is specially designed for sutureless intrascleral fixation with excellent anatomic and visual results but may also show specific complications. To the authors’ knowledge, this is the first report on how to efficiently manage harpoon erosion using this simple technique.
Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysis
Authors: List Emile B. , Krijgh David D. , Martin Enrico , Coert J. Henk
Published: January 2021

Residual limb pain (RLP) is associated with (partial) extremity amputations and is defined as pain felt in the remaining part of the amputated limb. A common cause of RLP is neuroma formation after nerve transections. Neuromas can be very painful and severely debilitating pathologies, preventing prosthetic use, reducing quality of life, and requiring medication. Residual limb pain and symptomatic neuromas are often not properly recognized by physicians explaining the varying prevalence in the literature. This systematic review and meta-analysis aim to provide a comprehensive overview of published literature on the prevalence of RLP and symptomatic neuroma after lower extremity amputation. Studies reporting the prevalence of RLP and symptomatic neuroma pain in patients who have had a lower extremity amputation published between 2000 and 2020 were identified in PubMed and Embase. Random-effects meta-analyses of proportions were performed to quantify the prevalence of RLP and symptomatic neuroma. Subgroups were identified and analysed. For RLP, the pooled prevalence was 59% (95% CI: 51-67). For symptomatic neuromas, the pooled prevalence was 15% (95% CI: 7-28). Residual limb pain subgroup analysis showed statistically significant higher prevalence in patients aged >50 years, follow-up >2 years, and in studies using a self-administered questionnaire for data collection. The prevalence of RLP and symptomatic neuroma in patients who have had a lower extremity amputation is 59% and 15%, respectively. Knowledge of their high prevalence may result in better awareness among physicians, in turn providing timely and adequate management.
The Utility of Mayo Clinic's Early Screen for Discharge Planning (ESDP) Tool: A Critical Narrative Review
Authors: Socwell Caitlyn P. , Kanagasaba Kumutha , Pope Rodney
Published: January 2021

Purpose:

The aim of this critical narrative review was to identify and synthesize available research evidence on the utility of Mayo Clinic's Early Screen for Discharge Planning (ESDP) tool to (1) identify adult patients early during their hospital stay who require referral to specialized hospital discharge planning services (SHDCPS) and (2) review its utility in predicting patient outcomes including hospital length of stay (LOS), readmission risk, and discharge destination. This review also begins by highlighting the important role of physical therapists in discharge planning.

Methods:

A critical narrative review was conducted of relevant studies identified through a systematic search of PubMed, CINAHL, Embase, and ProQuest databases and subsequent systematic screening and selection process. Studies were included and critically appraised if they met eligibility criteria: studies investigating the development, predictive validity and utility of the ESDP in hospital patient populations, and studies comparing the ESDP with other discharge planning tools. Key data were then extracted and tabulated before a critical narrative synthesis of key findings was completed.

Results:

Seven studies met the eligibility criteria, with 5 studies receiving a rating of “good” quality. The included studies investigated the ESDP tool in adults within acute inpatient hospital settings, including heart failure, colorectal surgery, general medical and surgical, and oncology wards.

Conclusion:

Five of the 7 included studies were of good quality and, together, studies provided evidence that the ESDP tool correctly identifies adults requiring referral to SHDCPS. However, further research of the ESDP tool is recommended to account for variations observed in special populations and expand knowledge of its utility to predict outcomes such as hospital LOS, readmission risk, and discharge destination.
Acne Vulgaris Significantly Lowers the Self-Concept of Girls in Junior High School: A Prospective Cross-Sectional Study
Authors: Liu Qian , Ge Yi-Ping , Cao Chun-Yan
Published: January 2021

Objective:

To evaluate the self-concept level of female students with acne vulgaris in junior high school and the relevant influencing factors.

Methods:

A total of 598 students in Grade 7 at two junior high schools in Nantong City, Jiangsu Province, China were sampled by cluster sampling method, and divided into two groups: the acne group and the healthy control. Both groups were surveyed using a self-designed demographic questionnaire, and the self-concept level was determined using the six-dimensional Piers-Harris Children's Self-Concept Scale (PHCSS). The differences were compared between two groups using Chi-square test, non-parametric test, and multiple regression analysis.

Results:

We released a total of 598 questionnaires, and 576 valid questionnaires were received, including 267 in the acne group and 309 in the healthy group. The subscale score of the popularity dimension of the PHCSS in the acne group (8.89 ± 1.780) was significantly lower than that in the healthy group (9.45 ± 1.78, P < 0.01). When only the girls were considered, compared with the healthy group, the acne group had a significantly lower total PHCSS score (58.72 ± 12.15 vs. 61.47 ± 11.14, P < 0.05) and significantly lower subscale scores for physical appearance and attributes (6.68 ± 3.26 vs. 7.97 ± 3.30, P < 0.05), happiness and satisfaction (7.70 ± 1.85 vs. 8.12 ± 1.47, P < 0.05), and popularity (8.69 ± 1.82 vs. 9.84 ± 1.67, P < 0.01). Furthermore, multiple regression analysis revealed the girls’ relationship with their parents and classmates, and the paternal educational background showed a significantly impact on the self-consciousness of the acne girls.

Conclusion:

Acne vulgaris significantly lowers the self-concept of girls in junior high school. The factors influencing the PHCSS scores of girls with acne were the relationship with parents and classmates, and the paternal educational background.
Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Lung Transplantation
Authors: Harano Takashi , Ryan John P. , Morrell Matthew R. , Luketich James D. , Sanchez Pablo G.
Published: January 2021

Extracorporeal membrane oxygenation (ECMO) is used as the last resort for primary graft dysfunction (PGD). The aim of this study is to explore the predictors and outcomes for early mortality in postlung transplant patients who required ECMO for PGD. Between January 2006 and December 2015, 1,049 cases of lung transplantation were performed at our center. Ninety-six patients required ECMO support after lung transplantation, 52 patients (54%) had PGD. Seven patients (13.5%) required venoarterial ECMO due to concomitant hemodynamical instability, and the others required venovenous ECMO. The patients were on ECMO for 5.00 ± 10.6 days. Forty-four patients (84.6%) were successfully decannulated. The 90 day, 1 year, and 5 year survival of patients who required ECMO for PGD after lung transplantation were 67.3%, 50.0%, and 31.5%, respectively. Cox regression indicated that when the patient was placed on ECMO later than 48 hours after transplantation, the patient could have higher in-house mortality (hazard ratio, 2.79; 95% CI, 1.21–6.43) and also higher 3 year mortality (hazard ratio, 2.30; 95% CI, 1.13–4.68) regardless of the patients’ preoperative conditions or complexity of lung transplantation. Earlier recognition of PGD and initiation of ECMO may be beneficial in this population.
Early Usage of Extracorporeal Membrane Oxygenation in the Absence of Invasive Mechanical Ventilation to Treat COVID-19-related Hypoxemic Respiratory Failure
Authors: Loyalka Pranav , Cheema Faisal H. , Rao Harshit , Rame J. Eduardo , Rajagopal Keshava
Published: January 2021

A subset of patients with coronavirus disease 2019 (COVID-19) develop profound respiratory failure and are treated via invasive mechanical ventilation (IMV). Of these, a smaller subset has severe gas exchange abnormalities that are refractory to maximal levels of IMV support. Extracorporeal membrane oxygenation (ECMO) has been used successfully in these circumstances. However, using ECMO only after failure of IMV exposes patients to the risks of ventilator-induced lung injury. We report a successful outcome using ECMO in the setting of COVID-19 in the absence of IMV failure in an awake, nonintubated patient. This approach may be beneficial for selected patients with COVID-19.
Relationship between primary percutaneous coronary intervention time of day, infarct size, microvascular obstruction and prognosis in ST-segment elevation myocardial infarction
Authors: Chen Shmuel , Redfors Björn , Crowley Aaron , Thiele Holger , Eitel Ingo , Ben-Yehuda Ori , Gkargkoulas Fotis , Mehdipoor Ghazaleh , Stone Gregg W.
Published: January 2021

Background

Whether the time of day of primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is associated with infarct size, microvascular obstruction (MVO), and prognosis is uncertain. We compared infarct size assessed by cardiac MRI (CMR) and clinical outcomes in STEMI patients according to the pPCI time of day from a large, individual patient-data pooled database.

Methods

We pooled patient-level data from five randomized pPCI trials in which infarct size was measured within 1 month by CMR. Patients were categorized according to the pPCI time of day.

Results

Among 1519 patients with STEMI, 794 (52.2%) underwent pPCI between 8:00 h and 15:59 h, 431 (28.4%) between 16:00 h and 23:59 h, and 294 (19.4%) between 24:00 h and 7:59 h. Infarct size was assessed in 1331 patients at a median of 3.0 days (interquartile range 2.0–5.0) after pPCI. Compared with patients who underwent PCI between 8:00 h and 15:59 h, infarct size was not significantly different for patients undergoing PCI from 16:00 h to 23:59 h [adjusted difference –0.7%, 95% confidence interval (CI) –3.1 to 1.7%, P = 0.46] or 24:00 h to 7:59 h (adjusted difference 0.9%, 95% CI –1.2 to 3.1%, P = 0.29). The time of day of pPCI was also unrelated to MVO and the 1-year risks of death or heart failure hospitalization.

Conclusion

In this large-scale, individual patient data pooled analysis, no association was found between the time of day of pPCI and infarct size, MVO, or prognosis after STEMI.
Association between angiographic and intravascular ultrasound optimizations after new-generation drug-eluting stent implantation and clinical outcomes
Authors: Cha Jung-Joon , Kim Daehoon , Kim Byeong-Keuk , Hong Sung-Jin , Ahn Chul-Min , Kim Jung-Sun , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo
Published: January 2021

Background

Uncertainty remains regarding the associations of angiographic optimization and intravascular ultrasound (IVUS) optimization after new-generation drug-eluting stent (DES) implantation.

Methods

From four randomized trials comparing outcomes between IVUS and angiography-guidance for long or chronic total occlusion (CTO) lesions, 1396 patients who underwent IVUS-guided new-generation DES implantation were enrolled. Of these, 1112 patients (80%) met angiographic optimization criteria (postprocedural diameter stenosis, ≤20%) and were further classified into the matched (same results for angiographic optimization and IVUS optimization) and the mismatched group (opposite results for angiographic optimization and IVUS optimization) according to the meeting of IVUS optimization criteria (minimal stent area, ≥5.5 mm2 or ≥80% of mean reference lumen area). The major adverse clinical events (MACE) were compared.

Results

Of 1112 patients with angiographic optimization, 675 patients met the IVUS optimization criteria (61%; matched), but 437 patients (39%; mismatched) failed to meet IVUS optimization criteria (false-positive rate = 76%). On multivariate analyses, age >60 years, reference vessel diameter ≤2.7 mm, left circumflex artery and lesion length ≥33 mm were significant predictors for the mismatched. When comparing the 12-month MACE rates, the mismatched group (6.8%) showed a significantly higher rate than the matched group (1.5%; hazard ratio = 2.62; 95% confidence interval = 1.20–5.72; P = 0.012), mainly driven by a higher target-vessel revascularization rate (6.4 vs 1.4%; P = 0.021).

Conclusion

Despite meeting angiographic optimization criteria in long or CTO lesions, more than one-third of the patients with IVUS-guided new-generation DES implantation failed to meet the IVUS optimization criteria and had worse clinical outcomes. Therefore, IVUS optimization should be considered for patients who had predictors of mismatch.
Routine fixed-dose heparin vs. ACT-guided heparin administration for elective PCI and its influence on patient in-hospital outcome: a retrospective study
Authors: Berkowitz Oron , Halabi Majdi , Goldberg Alexander , Rosenfeld Inna , Sharabi-Nov Adi , Regev-Avraham Zippi , Israeli Zeev
Published: January 2021

Objective

Activated clotting time (ACT)-based heparin dosing during percutaneous intervention (PCI) is recommended by Society guidelines. However, the relationship between ACT and outcome in the setting of elective PCI has not been sufficiently studied. We sought to evaluate the in-hospital outcome of patients undergoing elective PCI while receiving fixed-dose heparin without ACT measurement versus those with ACT-guided management.

Methods

This retrospective study included consecutive patients undergoing elective PCI in a single-center between 11/2015 and 12/2018. Patients were divided into two groups, depending on whether ACT was measured. Heparin-only anticoagulation and non-femoral procedures were allowed. Patient demographics, procedural data and in-hospital outcomes were collected. The primary outcome was in-hospital major adverse cardiovascular events (MACE), secondary (safety) outcomes were in-hospital definite stent thrombosis, Bleeding Academic Research Consortium bleeding, access-related complications (any) as well as peri-procedural complications.

Results

In total, 500 procedures were included in the study, 151 ACT and 349 fixed-dose. Patient demographics and medical history in both groups were well balanced, but those having ACTs were younger (63.2 ± 10.9 vs. 66.5 ± 11.3; P = 0.003) and less likely to have a history of coronary artery disease (74 vs. 82%; P = 0.032) or kidney failure. Procedural data were similar; however, total heparin dose and procedure length were higher in the ACT group (6232 ± 1388 vs.5032 ± 417 units; P < 0.001; 40.1 ± 14.0 vs. 30.3 ± 12.7 min; P < 0.001). Primary and secondary outcome events were rare and similar (MACE 1.1 vs. 1.3%; P = 0.86).

Conclusions

A fixed-dose heparin injection (5000 IU) approach for elective PCI while omitting ACT offers slightly shortened procedural time and similar in-hospital safety profile.
Impact of aging on the effects of intracoronary adenosine, peak hyperemia and its duration during fractional flow reserve assessment
Authors: Verdoia Monica , Gioscia Rocco , Suryapranata Harry , Kedhi Elvin , De Luca Giuseppe
Published: January 2021

Introduction

Functional assessment of coronary stenoses is crucial for determining the correct therapeutic strategy. Age-related modifications in cardiovascular function could alter the functional significance of an intermediate coronary lesion. Therefore, the aim of the present study was to investigate the impact of age on fractional flow reserve (FFR) measurements in patients with intermediate coronary artery disease.

Methods

We included patients undergoing coronary angiography at our Division of Cardiology from June 2008 to February 2019 for elective indication or recent acute coronary syndrome and receiving FFR assessment for an intermediate coronary stenosis (angiographic 40–70% stenoses). FFR measurement was performed by pressure-recording guidewire (Prime Wire; Volcano Imaging System Philips Healthcare, San Diego, California, USA), after induction of hyperemia with intracoronary boluses of adenosine (from 60 to 720 μg, with dose doubling at each step).

Results

We included in our study 276 patients, undergoing FFR evaluation on 314 lesions, that were divided according to age (< or ≥70 years). Elderly patients displayed a higher cardiovascular risk profile and received more often specific therapy. We found significantly higher FFR values and lower Delta FFR and time to recovery in patients with age ≥70 years old even with high-dose adenosine. Elderly patients showed a trend in lower percentage of positive FFRs, especially with high-dose (P = 0.09). Overall, any FFR ≤ 0.80 was observed in 33.5% of younger patients and 21.1% of patients ≥70 years (P = 0.02). Results were confirmed after correction for baseline differences [adjusted odds ratio (95% confidence interval) = 0.60 (0.33–1.09), P = 0.08].

Conclusion

This is one of the first studies investigating the impact of age on the measurement of FFR with high-dose adenosine. Patients with age >70 years old with intermediate CAD are more likely to have higher FFR values and lower duration of hyperemia after adenosine boluses, as compared with younger patients.
Nutritional status and severity of coronary artery disease
Authors: Kurmus Ozge , Aslan Turgay , Eren Murat , Akbuga Kursat , Erkan Aycan Fahri , Ekici Berkay , Akgul Ercan Ebru , Kervancioglu Celal
Published: January 2021

Objective

The aim of this study is to evaluate the association between Nutritional Risk Index (NRI), a simple tool to assess nutritional status, and coronary artery disease severity and complexity in patients undergoing coronary angiography.

Methods

This study is a retrospective analysis of 822 patients undergoing coronary angiography. Patients with previous revascularization were excluded. Gensini and SYNTAX scores were calculated according to the angiographic images to determine atherosclerosis severity. NRI was calculated as follows: NRI = [15.19 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. In patients ≥65 years of age, Geriatric NRI (GNRI) was used instead of NRI. GNRI was calculated as follows: GNRI = [14.89 × serum albumin (g/dl)] + [41.7 × (body weight/ideal body weight)]. Patients were then divided into three groups as previously reported: NRI < 92, NRI 92–98 and NRI > 98. Gensini and SYNTAX scores were compared between three groups.

Results

The mean age of study population was 61.9 ± 11.1 years. NRI < 92, 92–98, and >98 was measured in 212, 321 and 289 patients, respectively. There was no difference regarding to sex, BMI, smoking, hypertension and diabetes mellitus between three groups. Patients with NRI < 92 had the highest mean Gensini score than the patients with NRI 92–98 and NRI > 98 (38.0 ± 40.6 vs. 31.17 ± 42.4 vs. 25.8 ± 38.4, P = 0.005). Also patients with NRI < 92 had the highest mean SYNTAX score than the patients with NRI 92–98 and NRI > 98 (11.8 ± 12.9 vs. 9.3 ± 12.4 vs. 7.7 ± 11.8, P = 0.001). Also, Gensini score of ≥20 and high SYNTAX score of ≥33 were associated with lower NRI (P < 0.001 and P < 0.001, respectively).

Conclusion

In our study, nutritional status evaluated by the NRI was associated with more extensive and complex coronary atherosclerosis in patients undergoing coronary angiography.
Lack of anti-TNF drugs levels in fistula tissue – a reason for nonresponse in Crohn’s perianal fistulating disease?
Authors: Adegbola Samuel O. , Sarafian Magali , Sahnan Kapil , Pechlivanis Alexandros , Phillips Robin K.S. , Warusavitarne Janindra , Faiz Omar , Haddow James , Knowles Charles , Tozer Phil , Holmes Elaine , Hart Ailsa
Published: January 2021

Introduction

Anti-TNF therapy is recommended as treatment for patients with Crohn´s perianal fistulas. However, a significant proportion of patients have a sub-optimal response to anti-TNF therapy. Higher serum levels of anti-TNF agents have been associated with improved outcomes in perianal Crohn’s disease. Currently, it is unknown whether anti-TNF agent levels can be detected in tissue from fistula tracts themselves and whether this is associated with response.

Aims and methods

We undertook a pilot study to measure fistula tissue levels of anti-TNF medication (infliximab and adalimumab). We used a previously validated targeted proteomic technique, employing ultraperformance liquid chromatography-mass spectrometry, to detect/quantify anti-TNF drugs. Biopsies were obtained from fistula tracts of patients with Crohn’s disease on maintenance treatment; with idiopathic (cryptoglandular) fistula tissues used as negative controls as well as positive controls (by spiking the latter tissues with anti-TNF drugs).

Results

Tissue was sampled from the fistula tracts of seven patients with Crohn’s perianal disease (five patients were on adalimumab and two patients were on infliximab). The anti-TNF drugs, infliximab and adalimumab, were not detected in fistula samples from any of the Crohn’s patients despite detection in ‘spiked’ positive control samples.

Conclusion

Absence of detection of the anti-TNF drugs in fistula tissue raises the question on the role of tissue penetrance of anti-TNF drugs in response to therapy. Further work is required in a larger number of patients to validate the findings observed and investigate if any correlation exists between tissue and serum levels of anti-TNF and clinical outcome.

Predicting response in Crohn’s fistula patients on biologic therapy is difficult with no reliable biomarkers. This pilot study uses targeted proteomics to investigate the potential role of tissue drug levels in acting as a biomarker of treatment response.
Adding a liquid test meal to a standardized lactulose hydrogen breath test significantly influences abdominal symptom generation and hydrogen values
Authors: Schindler Valeria , Hente Juliane , Murray Fritz Ruprecht , Hüllner Martin , Becker Anton S. , Giezendanner Stéphanie , Schnurre Larissa , Bordier Valentine , Pohl Daniel
Published: January 2021

Objective

While single sugar tests are controversially discussed, combination tests with meals are gaining more attention. The aim of this study was to analyze the impact of adding a test meal to lactulose hydrogen breath tests (LHBT) on hydrogen values and abdominal symptoms in patients with functional gastrointestinal disorders (FGIDs).

Methods

Data of 81 FGID patients between 2014–2018 were analyzed. Patients underwent LHBT with 30 g lactulose + 300 mL water and a nutrient challenge test (NCT) including 400 mL liquid test meal + 30 g lactulose. To statistically assess the effect of a test meal on abdominal symptoms and H2, mixed-effect models were used.

Results

Adding a test meal to LHBT showed a significant increase in nausea [odds ratio (OR) 1.4; 95% confidence interval (CI), 1.1–1.7], decrease in abdominal pain (OR 0.7; 95% CI, 0.6–0.9), borborygmi (OR 0.5; 95% CI, 0.4–0.6), diarrhea (OR 0.4; 95% CI, 0.3–0.6), and H2 production (estimate −5.3, SE 0.7, P < 0.001). The effect on bloating was only significant in functional dyspepsia, irritable bowel syndrome-functional dyspepsia mixed type and functional abdominal pain/bloating (OR 0.1; 95% CI, 0.0–0.2; OR 1.7; 95% CI, 1.2–2.3 resp OR 4.4; 95% CI, 1.8–10.6).

Conclusions

Significant effects on abdominal symptoms and H2 production by adding a test meal to LHBT in FGID patients are shown. Increased occurrence of nausea may be caused by gastric/duodenal hypersensitivity; decreased H2, diarrhea and borborygmi by slower and more physiologic gastric emptying resulting in later arrival of the test substance in the bowel. We recommend NCTs instead of LHBT to more physiologically represent FGID patients’ meal-induced burden.
Predictive value of noninvasive indices in chronic hepatitis B virus-related fibrosis
Authors: Öznur Meltem , Topçu Birol , Çelikkol Aliye
Published: January 2021

Objectives

Despite being an invasive method, liver biopsy followed by pathological grading remains the gold standard in evaluating liver fibrosis resulting from chronic hepatitis B virus (HBV) infection. The present study aims to evaluate the utility of biochemical parameters and their derived indices in predicting development of fibrosis related to HBV infection.

Patients and methods

Pathology results and biochemical parameters of patients who underwent liver biopsy were retrieved from electronic archive records dated 2010–2019 and evaluated retrospectively. Pathological fibrosis grading was performed as per Ishak scoring, with scores of 1–2 considered as mild fibrosis and 3–6 as advanced fibrosis.

Results

The mean age of 302 patients was 37.69 ± 11.33 years. Of the 302 patients, 230 (76.2%) had mild fibrosis and 72 (23.8%) had advanced fibrosis. Age-platelet index, aspartate aminotransferase/platelet ratio index, fibrosis-4 (FIB-4), modified fibrosis-4, platelets count, aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index, Goteborg University Cirrhosis Index and King’s score were markedly and significantly higher in patients with advanced fibrosis than those with mild fibrosis. FIB-4, age-platelet index and King’s score had higher (>80%) area under the curve values than other indices in the receiver operating characteristics analysis. Evaluation of sensitivity, specificity and accuracy of these indices with the specified cut-off values revealed 87% sensitivity with FIB-4, 70% specificity with King’s score and 72% accuracy with the age-platelet index.

Conclusion

In this study, the highest rates of sensitivity, specificity and accuracy in distinguishing and predicting liver fibrosis were observed with the noninvasive indices FIB-4, King’s score and the age-platelet index, respectively.
Mucocutaneous manifestations in patients with inflammatory bowel disease: a decade study from a Greek cohort
Authors: Koumaki Dimitra , Machaira Angeliki , Katoulis Alexander C. , Bitados Panagiotis , Orfanoudaki Eleni , Foteinogiannopoulou Kalliopi , Stefanidou Maria , Krasagakis Konstantinos , Koutroubakis Ioannis E.
Published: January 2021

Background

We sought to investigate the prevalence of mucocutaneous manifestations (MCM) and potential associations with clinical characteristics in Greek patients with IBD.

Methods

This was a retrospective observational single-center study. Patients with IBD diagnosis attending a tertiary referral hospital in Heraklion, Crete, from January 2010 to January 2020 were included. Data were extracted with relevant medical information from the IBD registry. Standard statistical tests, descriptive statistics tests, chi-square, Pearson correlation and multivariate analysis tests were performed, using IBM SPSS Statistics 25.

Results

A total of 806 IBD patients were included in the study: 463 (57.4%) males, 441 (54.7%) Crohn’s Disease, 352 (43.7%) ulcerative colitis and 13 (1.6%) IBD unclassified (IBD-U). Mean age was 50.67 ± 17.67 years, mean age of IBD diagnosis 36.67 ± 16.53 years and mean disease duration 13.65 ± 9.89 years. The prevalence of MCM was 171/806 (21.2%), 9.65% in ulcerative colitis and 30.84% in CD. The presence of MCM was significantly correlated with younger age of IBD diagnosis, longer IBD duration, CD diagnosis, inflammatory behavior and ileal or ileocolonic location of CD, extensive colitis in ulcerative colitis, intestinal manifestations (EIMs) and treatment with immunosuppressant or anti-TNFa. The development of MCM was independently associated with the presence of other EIMs odds ratio (OR), 4.03 [95% confidence interval (CI), 2.60–6.24; P < 0.001] and treatment with immunosuppressant (OR, 1.87; 95% CI, 01.14–3.07; P = 0.013) or anti-TNFa (OR = 2.47; 95% CI, 1.59–3.84; P < 0.01).

Conclusions

In our study, about one-fifth of IBD patients developed MCM that was more frequently present in CD than in ulcerative colitis.
Factors influencing health-related quality of life in patients with Barrett’s esophagus: a qualitative focus group study
Authors: van der Ende-van Loon Mirjam , Brouwers Marleen , de Munnik Suzanne , Nieuwkerk Pythia , Curvers Wouter , Schoon Erik
Published: January 2021

Introduction

Barrett’s esophagus is a premalignant condition in the lower part of the esophagus, caused by gastroesophageal reflux disease. Previous studies found that having a Barrett’s esophagus is associated with a significant decrease of health-related quality of life (HRQOL). Over the past decade, a considerable amount of literature has been published on the development of endoscopic treatment for (early) neoplasia in Barrett’s esophagus. Though, currently very little is known about the impact of those endoscopic treatments on HRQOL from the perspective of patients. In this study, we aim to assess the factors influencing HRQOL according to Barrett’s esophagus patients.

Methods

By using a qualitative focus group design, patients with nondysplastic Barrett’s esophagus and patients with a history of endoscopic treatment for Barrett’s dysplasia were included. Data were analysed following the conventional content analyses approach.

Results

A total of 34 patients participated in the four focus group sessions. Experiencing symptoms was valued as the most important factor in both groups. Other factors identified as important HRQOL influencers were: use of medication, fear of cancer and trust in physicians and endoscopic procedures.

Conclusions

In general, Barrett’s esophagus patients experienced a good HRQOL, with a minimal emotional burden from the diagnosis of Barrett’s esophagus. Most influencing factor on HRQOL was: experiencing reflux and dyspepsia symptoms. This study underlines the importance of adequate gastroesophageal reflux treatment and providing information to Barrett’s esophagus patients, tailored to their personal needs.
Molecular analysis of fine-needle aspiration cytology in thyroid disease: where are we?
Authors: Grani Giorgio , Sponziello Marialuisa , Filetti Sebastiano , Durante Cosimo
Published: January 2021

Purpose of review

The prevalence of thyroid nodules in the general population is high but only about 5% are malignant lesions. Cytology is usually appropriate to rule out malignancy in sonographically suspicious nodules but in many cases, reports are indeterminate. Molecular testing is a more recent approach to rule out malignancy and guide subsequent management.

Recent findings

Although several different molecular testing approaches have proven useful in reducing unnecessary surgery, there are still several remaining issues, such as the possible occurrence of RAS mutations (which are difficult to interpret in clinical management) and the role of molecular analysis in specific histotypes, such as Hürthle cell carcinomas. Furthermore, conclusive evidence is lacking regarding the cost-effectiveness and appropriateness of surgical options following molecular tests.

To be useful in clinical practice, molecular tests should be applied to appropriate candidates. In truly uncertain thyroid nodules in which diagnostic surgery may be considered, molecular testing may change the clinical approach and ‘save’ a number of thyroids.
In‐hospital Growth of Very Low Birth Weight Preterm Infants
Authors: Kemp Hannelie , Becker Piet , Wenhold Friedeburg Anna Maria
Published: January 2021

Objective:

Amidst a high prevalence of prematurity, limited research on the growth of very low birth weight (VLBW) preterm infants and the availability of a reformulated fortifier c(RF), the study aimed to compare in‐hospital growth of such infants receiving exclusively human milk fortified with either of 2 different formulations in a tertiary South African hospital.

Methods:

In a prospective comparative effectiveness design, intakes and growth of VLBW infants on the Original Fortifier (OF; 2016–2017) were compared with those receiving RF (2017–2018). Daily intake was calculated using published composition of preterm and mature milk with fortifier (OF: 0.2 g protein, 3.5kcal/g powder; RF: 0.4 g protein, 4.4 kcal/g powder). Change in z scores from start to end of fortification for weight (WFAZ), length (LFAZ), and head circumference (HCFAZ) for age was the primary outcome. Additionally, weight gain velocity (g · kg−1 · day−1) and gain in length and head circumference (HC) (cm/week) were calculated.

Results:

Fifty‐eight infants (52% girls; gestational age: 30 ± 2 weeks; birth weight: 1215 ± 187 g) received OF for 16 days and 59 infants (56% girls; gestational age: 29 ± 2 weeks; birth weight 1202 ± 167 g) received RF for 15 days. Protein intake of RF (3.7 ± 0.4 g · kg−1 · day−1) was significantly higher (P < 0.001) than of OF (3.4 ± 0.2 g · kg−1 · day−1). Protein‐to‐energy ratio of RF (2.6 ± 0.2 g/100 kcal) was significantly higher (P < 0.001) than of OF (2.3 ± 0.1 g/100 kcal). In both groups, WFAZ and LFAZ decreased; HCFAZ improved slightly. No significant differences (P > 0.05) were noted between the 2 groups for change in z scores, weight gain velocity, length or HC gain.

Conclusions:

Despite a modest increase in protein intake and protein‐to‐energy ratio, the growth of VLBW infants on RF was not better than on OF during their hospital stay.
Integration of eHealth Into Pediatric Inflammatory Bowel Disease Care is Safe: 3 Years of Follow-up of Daily Care
Authors: Carlsen Katrine , Frederiksen Nicoline Willum , Wewer Vibeke
Published: January 2021

Objectives:

The aim of the study was to evaluate integration of an eHealth solution,
www.young.constant-care.com
, into daily care (I-eHealth).

Methods:

The I-eHealth solution was offered to inflammatory bowel disease (IBD) patients ages 10 to 17 years old in nonbiological treatment. The application was used monthly and in case of flare-ups. Blood and fecal calprotectin (FC) were tested every 3 months and during flare-ups. A total inflammation score (based on symptoms and FC) was visualized for the patient in a traffic light curve. An IBD nurse followed up on the registrations every 2 weeks. Patients had 1 yearly planned visit at the hospital. On-demand visits were arranged depending on the total inflammation. I-eHealth results were compared with data from a previous randomized clinical trial (RCT)-eHealth study (the control group of which had 4 planned annual visits).

Results:

Thirty-six IBD patients were followed by I-eHealth, mean age 14.7 years (SD 7.75). The median (interquartile range [IQR]) duration of using I-eHealth was 1.9 years (0.29–2.51), equal to 66.11 patient-years, compared with 40.45 in the RCT-eHealth group and 46.49 in the RCT-control group. On-demand visits per patient-year did not differ between the groups: 1.13 (I-eHealth), 1.16 (RCT-eHealth), and 0.84 (RCT-control) (P = 0.84/0.85). Hospitalizations and acute outpatient visits per patient-year did not differ between the groups: 0.11 and 0.11 (I-eHealth), 0.05 and 0.02 (RCT-eHealth), 0.11 and 0.11 (RCT-control) (P = 0.17/0.81 and 0.12/0.81). Time to first escalation of medication, and time to first on-demand visit, did not differ between the I-eHealth group and data from the clinical trial (Log rank: P = 0.25 and P = 0.61).

Conclusions:

I-eHealth is comparably with results from eHealth under RCT supervision.
Impact of COVID-19 on Maternal Mental Health
Authors: Goyal Deepika , Selix Nancy W.
Published: January 2021

The COVID-19 pandemic led to several states mandating social distancing and sheltering in place along with a shift in health care delivery, unprecedented unemployment rates, financial stress, and emotional concerns. For pregnant and postpartum women, limited social support and social isolation with social distancing and fear of COVID-19 exposure or infection for themselves, their fetus, or their newborn infants, have implications for maternal mental health. An overview of the potential impact of COVID-19 on mental health risk for pregnant and postpartum women is presented with implications for nursing practice to promote maternal–infant wellbeing.
PROgesterone Therapy for Endometrial Cancer Prevention in Obese Women (PROTEC) Trial: A Feasibility Study
Authors: Derbyshire Abigail E. , Allen Jennifer L. , Gittins Matthew , Lakhiani Bhavna , Bolton James , Shaw Joseph , Pemberton Philip W. , Needham Michelle , MacKintosh Michelle L. , Edmondson Richard J. , Kitchener Henry C. , Crosbie Emma J.
Published: January 2021

(Abstracted from Cancer Prev Res (Phila) 2020; doi: 10.1158/1940-6207.CAPR-20-0248)

Approximately 40% of endometrial cancers are thought to be directly attributable to obesity. The mechanism responsible for this association involves stimulation of the endometrium by adipose-derived estrogen unopposed by progesterone in anovulatory and postmenopausal women in addition to the effects of insulin resistance and chronic inflammation.
State-Wide Utilization and Performance of Traditional and Cell-Free DNA-Based Prenatal Testing Pathways: The Victorian Perinatal Record Linkage (PeRL) Study
Authors: Lindquist A. , Hui L. , Poulton A. , Kluckow E. , Hutchinson B. , Pertile M. D. , Bonacquisto L. , Gugasyan L. , Kulkarni A. , Harraway J. , Howden A. , McCoy R. , da Silva Costa F. , Menezes M. , Palma-Dias R. , Nisbet D. , Martin N. , Bethune M. , Poulakis Z. , Halliday J.
Published: January 2021

(Abstracted from Ultrasound Obstet Gynecol 2020;56:215–224)

In recent years, the use of combined first-trimester screening (CFTS) and cell-free DNA (cfDNA) screening has increased. With the rise of CFTS and cfDNA prenatal testing, there has been a dramatic decrease in the number of invasive diagnostic tests performed during pregnancy.
Expression of Immune Checkpoint Regulators, Cytotoxic T-Lymphocyte Antigen-4, and Programmed Death-Ligand 1 in Epstein-Barr Virus-associated Nasopharyngeal Carcinoma
Authors: Ahmed Mona M. , Gebriel Manar G. , Morad Emad A. , Saber Ibrahim M. , Elwan Amira , Salah Mona , Fakhr Ahmed E. , Shalaby Amany M. , Alabiad Mohamed A.
Published: January 2021

Background:

Nasopharyngeal carcinoma (NPC) is the most common cancer arising from the nasopharynx with a poor prognosis. Targeting immune checkpoint is one of the new promising lines in cancer treatment. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed death-ligand 1 (PD-L1) are immune checkpoints that regulate T-cell immune function.

Aim:

This work aimed to assess the immunohistochemical expression of PD-L1 and CTLA-4 in NPC and their ability to predict survival and response therapy and to check their validity as immunotherapy targets. Twenty-six cases of NPC were studied by immunohistochemistry for PD-L1 and CTLA-4 and by nested polymerase chain reaction followed by DNA sequencing for the presence of EBNA-1 gene of Epstein-Barr virus (EBV). All investigated cases were diagnosed and treated in the Zagazig University Hospital in the period from August 2015 to July 2018. EBNA-1 gene was identified in 84.6% of the cases. Whereas the expression of PD-L1 was noted in 46.2% of all cases studied, 54.6% of EBV-associated NPCs were found to express PD-L1. There was a significant association between PD-L1 expression and the advanced stage of the tumor (P<0.001). CTLA-4 expression was observed in 88.4% of all NPC cases as cytoplasmic staining in both tumor cells and tumor-infiltrating lymphocytes. CTLA-4 expression in lymphocytes was associated with the presence of EBV. A significant association was detected between CTLA-4 and tumor-infiltrating lymphocyte expression on one side and the stage of the tumor on the other. High expression of CTLA-4 was significantly associated with disease progression and worse overall survival.

Conclusion:

PD-L1 and CTLA-4 are adverse prognostic markers in NPC. The authors propose that targeted therapy against PD-L1 and CTLA-4 will be a hopeful therapy for cases of NPC with resistance to concurrent chemoradiation treatment in Egypt, especially EBV-associated cases.
Childhood Acute Urticaria and Seasonal Patterns Presenting in the Emergency Department of a Teaching Hospital in London, United Kingdom
Authors: Koumaki Dimitra , Koumaki Vasiliki , Boumpoucheropoulos Sotirios , Katoulis Alexander , Laguda Bisola
Published: January 2021

Objectives

To characterize the clinical presentation, possible trigger factors and seasonality of acute urticaria (AU) in children referred to the emergency department in a teaching hospital in London, United Kingdom.

Methods

This was a retrospective descriptive study. One hundred and sixty-three consecutive patients younger than 18 years with the diagnosis of AU who attended accident and emergency department from January 2018 until January 2020 at Chelsea and Westminster Hospital in London, United Kingdom, were included in the study. Descriptive statistics were performed using IBM SPSS 25.

Results

In total, 163 patients younger than 18 years, 82 (50.3%) boys and 81 (49.7%) girls. The median age of patients with AU was 4 years (interquartile range, 6 years). In 120 of (73.6%) 163 patients, there was no clear trigger of AU, in 17 (10.4%) of 163 patients, upper respiratory infection was considered as a potential trigger of AU, followed by food in 14 (8.6%) cases, medications in 9 (5.5%) cases, hymenoptera sting in 1 (0.6%) case, and contact urticaria 2 (1.2%) cases. Seventeen (10.4%) of the patients were admitted into the hospital as a result of their urticaria. The majority of AU urticaria cases were reported in autumn with 76 (46.6%) cases with most of AU cases occurring in November (34/163, 20.9%).

Conclusions

A total of 163 cases of AU were identified between January 2018 and January 2020. A seasonal trend of AU in autumn was observed. Respiratory infections were found to be the most commonly associated potential trigger of AU cases.
Implementing Paper Documentation During an Influenza Surge in a Pediatric Emergency Department
Authors: Berkowitz Deena , Simpson Joelle , Cohen Joanna S. , Kadakia Ashaini , Badolato Gia , Breslin Kristen A.
Published: January 2021

Objective

We hypothesized that a paper documentation and discharge bundle can expedite patient care during an influenza-related surge.

Methods

Retrospective cohort study of low-acuity patients younger than 21 years surging into a pediatric emergency department between January and March 2018 with influenza-like illness. Patient visits documented using a paper bundle were compared with those documented in the electronic medical record on the same date of visit. The primary outcome of interest was time from physician evaluation to discharge for patient visits documented using the paper bundle compared with those documented in the electronic medical record. Secondary outcome was difference in return visits within 72 hours. We identified patient and visit level factors associated with emergency department length of stay.

Results

A total of 1591 patient visits were included, 1187 documented in the electronic health record and 404 documented using the paper bundle. Patient visits documented using the paper bundle had a 21% shortened median time from physician evaluation to discharge (41 minutes; interquartile range, 27–62.8 minutes) as compared with patient visits documented in the electronic health record (52 minutes; interquartile range, 35–61 minutes; P < 0.001). There was no difference in return visits (odds ratio, 0.7; 95% confidence interval, 0.2, 2.2).

Conclusions

Implementation of paper charting during an influenza-related surge was associated with shorter physician to discharge times when compared with patient visits documented in the electronic health record. A paper bundle may improve patient throughput and decrease emergency department overcrowding during influenza or coronavirus disease–related surge.