bluuebunny/crossref_metadata_2025 huggingface dataset:
Cortical Thickness in Crouzon–Pfeiffer Syndrome: Findings in Relation to Primary Cranial Vault Expansion
Authors: Wilson Alexander T. , de Planque Catherine A. , Yang Sumin S. , Tasker Robert C. , van Veelen Marie-Lise C. , Dremmen Marjolein H.G. , Vrooman Henri A. , Mathijssen Irene M.J.
Published: April 2021

Background:

Episodes of intracranial hypertension are associated with reductions in cerebral cortical thickness (CT) in syndromic craniosynostosis. Here we focus on Crouzon–Pfeiffer syndrome patients to measure CT and evaluate associations with type of primary cranial vault expansion and synostosis pattern.

Methods:

Records from 34 Crouzon–Pfeiffer patients were reviewed along with MRI data on CT and intracranial volume to examine associations. Patients were grouped according to initial cranial vault expansion (frontal/occipital). Data were analyzed by multiple linear regression controlled for age and brain volume to determine an association between global/lobar CT and vault expansion type. Synostosis pattern effect sizes on global/lobar CT were calculated as secondary outcomes.

Results:

Occipital expansion patients demonstrated 0.02 mm thicker cortex globally (P = 0.81) with regional findings, including: thicker cortex in frontal (0.02 mm, P = 0.77), parietal (0.06 mm, P = 0.44) and occipital (0.04 mm, P = 0.54) regions; and thinner cortex in temporal (−0.03 mm, P = 0.69), cingulate (−0.04 mm, P = 0.785), and, insula (−0.09 mm, P = 0.51) regions. Greatest effect sizes were observed between left lambdoid synostosis and the right cingulate (d = −1.00) and right lambdoid synostosis and the left cingulate (d = −1.23). Left and right coronal synostosis yielded effect sizes of d = −0.56 and d = −0.42 on respective frontal lobes.

Conclusions:

Both frontal and occipital primary cranial vault expansions correlate to similar regional CT in Crouzon–Pfeiffer patients. Lambdoid synostosis appears to be associated with cortical thinning, particularly in the cingulate gyri.
Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients
Authors: Moon Hyoung-Jin , Gao Zhan-Wei , Hu Zhi-Qi , Wang Hang , Wang Xiao-Jun
Published: April 2021

Background:

Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study.

Methods:

We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions.

Results:

Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics.

Conclusions:

Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.
Perception of Breast Reconstruction among 10,299 Indian Women
Authors: Shanmugakrishnan R. Raja , Sabapathy S. Raja
Published: April 2021

Background:

Less than 1% of women undergo breast reconstruction after mastectomy in India. To understand if the perception of breast reconstruction among Indian women is a contributing factor, a survey of 10,299 women was done.

Method:

In total, 10,299 women answered questions from a questionnaire with the help of social workers (10,005) and using the Surveymonkey App (294).

Results:

An estimated 48.8% of women were aware of breast reconstruction. Around 77.5% felt that women would feel depressed after mastectomy, and 76.5% said they would prefer breast reconstruction. Irrespective of age and financial status, most women preferred breast reconstruction after mastectomy. Autologous reconstruction (79.6%) was preferred to implant reconstruction (20.4%). An estimated 71.3% liked the idea of a DIEP flap. When explained that DIEP flap may take 6–8 hours of surgery and cost about US $3500, only 48.8% would go for a DIEP flap. For early breast cancers, women preferred breast conservation surgery (65.7%) to mastectomy and breast reconstruction (34.3%). Women felt that the best way to increase awareness of breast reconstruction would be by social media (47.8%) followed by word of mouth (16.4%), television (13.4%), newspapers (11.7%), and magazines (10.6%).

Conclusions:

Although the breast reconstruction rates are very low, women preferred breast reconstruction to mastectomy alone regardless of age and financial status. The surgical teams should devise strategies to assure woman that they can achieve reliable reconstruction at an affordable cost. Increasing experience and reduction of operation time would make autologous breast reconstruction affordable. This strategy could apply to most developing economies.
Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity
Authors: Sakamoto Yoshiaki , Miyamoyo Junpei , Kishi Kazuo
Published: April 2021

Background:

It is generally accepted that the alar base on the cleft side in the cleft lip nose is displaced outward and downward; therefore, it is rotated inward and upward in almost all procedures for cleft lip closure. However, nostril narrowing and collapse of the lower lateral cartilage on the cleft side are sometimes experienced. In this retrospective study, we investigated whether the preoperative alar base on the cleft side is displaced outward and downward.

Methods:

This was a retrospective evaluation using preoperative frontal images obtained from patients with unilateral cleft lip (n = 245). The midcolumellar and subalare points were placed, and each ratio was analyzed and compared to those of age-matched controls (n = 40).

Results:

The subalare on the noncleft side and subnasale were displaced upward and outward. In contrast, the subalare on the cleft side was displaced downward and inward. The displacement of the subalare was greater on the noncleft than on the cleft side. There were no significant differences between male and female patients and between the left and right sides. Among the complete cleft lip and palate, incomplete cleft lip and palate, complete cleft lip and alveolus, incomplete cleft lip and alveolus, and microform cleft lip groups, the complete cleft lip and palate group showed the greatest displacement.

Conclusion:

The cleft alar base appeared to shift outward and downward because of an optical illusion, but in fact, both alar bases shifted; the alar base on the cleft side was displaced inward and downward, and the alar base on the noncleft side was displaced outward and upward.
Superficial Temporal Artery Pseudoaneurysm following Midface Thread-lift
Authors: Niimi Yosuke , Hayakawa Nami , Kamei Wataru , Hori Keijiro , Niimi Yu , Honda Takashi , Sakurai Hiroyuki
Published: April 2021

Facial thread-lifting has been popular because of its ease and safety with short down time. However, many physicians perform the procedure in cosmetic clinics, which can result in several complications. This report describes the surgical treatment of iatrogenic superficial temporal artery pseudoaneurysm (STAP) following thread-lifting. A 27-year-old man developed a painless, pulsating soft mass in the pre-auricular region after undergoing a thread-lift in a private cosmetic clinic 3 months before being referred to the authors’ hospital. The mass was diagnosed as a STAP, using magnetic resonance imaging. The pseudoaneurysm was resected completely, and the superficial temporal artery was microsurgically reconstructed. Although there are some surgical procedures for treating STAP, such as surgical resection and embolization, the former is considered the first choice. Physicians should be trained before performing thread-lifting and must know the possibility of an iatrogenic STAP appearing after the procedure and the face and neck anatomy to prevent complications.
Volume Change of Muscle and Fat Portions of Latissimus Dorsi Myocutaneous Flap after Breast Reconstruction
Authors: Kang Chang Min , Shim Jeong Su , Park Sung Hwan , Jeong Young Ju , Seol Ki Ho , Kwak Sang Gyu
Published: April 2021

Background:

Myocutaneous flaps are composed of muscle and fat portions, and exhibit volume changes with time. However, no consideration is generally given to volume changes of muscle and fat portions occurring in the flap. Therefore, we conducted this study to analyze the volume changes of muscle and fat portions of pedicled latissimus dorsi myocutaneous flaps over time.

Methods:

Sixteen patients who underwent breast reconstruction using a latissimus dorsi myocutaneous flap between 2009 and 2017 were enrolled in this study. Using their postoperative computed tomography scan data, we measured the volume of muscle and fat portions of the flap, and performed a statistical analysis of volume changes over time. We also measured the volume of latissimus dorsi muscle on the opposite side and compared the difference in muscle volume.

Results:

The volume of the muscle portion of latissimus dorsi myocutaneous flap decreased by approximately 24%, from 6 months to postoperative year 2; from the third year, it shrank with a decrease rate similar to that of normal muscle. The fat portion of the flap showed no regular volume changes.

Conclusions:

Atrophy of the muscle portion is the primary cause of volume change of latissimus dorsi myocutaneous flaps over time. it is necessary to understand the difference in the volume change patterns of the muscle and fat. To maintain a long-term satisfactory result, it is better to make the maximum possible use of the relatively stable fat portion rather than the muscle portion.
Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision: A Prospective, Multi-centered, Double-blinded Study
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Jenwitheesuk Kamonwan , Eua-angkanakul Kant , Winaikosol Kengkart , Punyavong Pattama , Wongkietkachorn Nuttapone , Wongkietkachorn Supawich , Salyapongse A. Neil
Published: April 2021

Background:

During burn excision, the clinical judgment whether to excise or not excise the area with indeterminate burn depth is difficult. Indocyanine green angiography (ICGA) has been reported to provide high accuracy in diagnosing indeterminate burns. This study aims to evaluate the complete wound closures in both short-term and long-term outcomes after using ICGA precise marking to guide indeterminate burn excision.

Methods:

This was a prospective, multi-centered, double-blinded, experimental study. The participants were admitted to the hospital with indeterminate burn wounds. ICGA precise marking was performed. The deep second-degree burn was painted, excised, and subsequently covered with skin grafts and measured on day 5. The superficial burns were measured on day 21. All wounds were followed-up at two months.

Results:

Thirty indeterminate burn sites were included in this study. Using ICGA precise marking, the overall rate of short-term complete wound closure, which combined superficial and deep burns, was found to be as high as 96.7% (29/30). The long-term complete wound closures at two months confirmed the short-term result and yielded 100.0% of complete wound closure. The complete wound closures between the short-term and long-term measurements were not significantly different (P > 0.999).

Conclusions:

Using ICGA precise marking to guide indeterminate burn excision resulted in an excellent rate of complete wound closure and an insignificant difference between short-term and long-term wound outcomes. ICGA is a competent method to aid decision-making in burn surgery of the indeterminate area.
Nipple–Areola Complex Reconstruction Using a Skin Graft and Nipple Sharing after Wise-pattern Central Lumpectomy
Authors: Schwartz Jean-Claude D.
Published: April 2021

Patients with central breast cancers historically underwent mastectomy, as the aesthetic implications of removing the nipple–areola complex and central breast tissue left disfiguring defects after breast conservation. The introduction of oncoplastic techniques allowed for central lumpectomies in ptotic patients, as the excess skin and gland could be mobilized centrally to fill the defect and even immediately reconstruct a nipple and areola. These reconstructions used excess skin on the Wise pattern vertical limbs to create a nipple, or on a “neopedicle” where both the areola and nipple were reconstructed and then mobilized superiorly into position as would be performed for a conventional mastopexy or reduction. These techniques importantly allowed for the immediate reconstruction of a nipple and areola in patients who often imminently required radiotherapy and where subsequent surgery would be challenging. Here we describe another option for immediate nipple and areola reconstruction in these patients—nipple sharing and a skin graft—a well-established approach in post-mastectomy patients but never previously described for patients undergoing breast conservation.
Applying a Health Equity Lens to Urinary Incontinence
Authors: BROWN OLUWATENIOLA , SIMON MELISSA A.
Published: April 2021

Health equity is attained when everyone has the opportunity achieve the health they envision; however, health disparities are a barrier to health equity. As health disparities specific to urogynecology exist, it is critical to examine and contextualize them in a framework that improves understanding of what factors may drive these disparities to craft effective solutions. This article will review what we currently know about urinary incontinence disparities and provide a framework for evaluation as well as a framework for advancing health equity in the care of diverse patient populations with urinary incontinence.
Relationship between angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and COVID-19 incidence or severe disease
Authors: Tse Gary , Zhou Jiandong , Lee Sharen , Wong Wing Tak , Li Xintao , Liu Tong , Cao Zhidong , Zeng Daniel Dajun , Wai Abraham K.C. , Wong Ian Chi Kei , Cheung Bernard Man Yung , Zhang Qingpeng
Published: April 2021

Background:

Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may be associated with higher susceptibility of COVID-19 infection and adverse outcomes. We compared ACEI/ARB use and COVID-19 positivity in a case–control design, and severity in COVID-19 positive patients.

Methods:

Consecutive patients who attended Hong Kong's public hospitals or outpatient clinics between 1 January and 28 July 2020 for COVID-19 real time-PCR (RT-PCR) tests were included. Baseline demographics, past comorbidities, laboratory tests and use of different medications were compared between COVID-19 positive and negative patients. Severe endpoints for COVID-19 positive patients were 28-day mortality, need for intensive care admission or intubation.

Results:

This study included 213 788 patients (COVID-19 positive: n = 2774 patients; negative: n = 211 014). In total, 162 COVID-19 positive patients (5.83%) met the severity outcome. The use of ACEI/ARB was significantly higher amongst cases than controls (n = 156/2774, 5.62 vs. n = 6708/211014, 3.17%; P < 0.0001). Significant univariate predictors of COVID-19 positivity and severe COVID-19 disease were older age, higher Charlson score, comorbidities, use of ACEI/ARB, antidiabetic, lipid-lowering, anticoagulant and antiplatelet drugs and laboratory tests (odds ratio >1, P < 0.05). The relationship between the use of ACEI/ARB and COVID-19 positivity or severe disease remained significant after multivariable adjustment. No significant differences in COVID-19 positivity or disease severity between ACEI and ARB use were observed (P > 0.05).

Conclusion:

There was a significant relationship between ACEI/ARB use and COVID-19 positivity and severe disease after adjusting for significant confounders.
The Prevalence of Complementary and Integrative Health Approach Use and Quality of Life Among Patients With Heart Failure
Authors: Gok Metin Zehra , Gulbahar Merve
Published: April 2021

This study aimed to determine the prevalence of complementary and integrative health approach (CIHA) use in patients with heart failure (HF) and compare quality of life (QoL) between CIHA users and nonusers. This was a cross-sectional, descriptive, and comparative study including 130 patients with HF in Turkey. The data were collected using the sociodemographic and CIHA information form and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The mean age was 64.51 ± 10.40 years. Furthermore, 26.1% of the participants had used at least one form of CIHA in the previous year. The most used CIHA was herbal therapies (94.2%). The total scores of the KCCQ were 47.70 ± 9.50 in the study, and a statistically significant difference was found in the total scores of the KCCQ between CIHA users and nonusers. The findings of this study revealed that more than a quartile of patients with HF used at least one form of CIHA. Further prospective studies are warranted to follow up with patients having HF who use any form of CIHA for a longer period and determine other parameters that directly influence QoL.
Favorable Outcomes From an In-person and Online Feasibility Mindful Moment Pilot Study
Authors: Patronis Stephanie , Staffileno Beth A.
Published: April 2021

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a −31% change in emotional exhaustion (P = .079), a −31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses' perceived stress pre/post–Mindful Moment session, with percent changes ranging from −35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.
Analysis of Immune Cells on Donor Corneal Endothelium After Corneal Transplantation Using the HRT-Rostock Cornea Module
Authors: Okumura Naoki , Velumani Thenmozhi , Hadiya Farhath , Padmanaban Vasanthi , Komori Yuya , Hanada Naoya , Hirono Taisuke , Srinivas Sangly P. , Koizumi Noriko , Padmanabhan Prema
Published: April 2021

Purpose:

The aim of this study was to investigate the immune cells on corneal endothelium of the graft in patients who underwent penetrating keratoplasty (PK), Descemet-stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK).

Methods:

A total of 43 eyes of 43 patients who underwent PK (17 eyes), DSEK (13 eyes), and DMEK (13 eyes) and who did not show any sign of graft rejection were recruited for the study. Patients who underwent cataract surgery (26 eyes) served as controls. Immune cells on the corneal endothelium were examined with laser in vivo confocal microscopy. The associations between the corneal endothelial cell density, type of keratoplasty, aqueous flare, repeated keratoplasty, and time after surgery versus the density of immune cells were investigated.

Results:

In vivo confocal microscopy visualized similar numbers of immune cells on the corneal endothelium in the PK, DSEK, and DMEK groups, whereas no immune cells were observed in any of the control patients. The numbers of immune cells tended to be higher in regraft eyes in the PK group (P = 0.00221) and in the DSEK group (P = 0.168) than those in the primary graft eyes. No significant association was found between the density of immune cells and corneal endothelial cell density in the PK, DSEK, and DMEK groups.

Conclusions:

Immune cells were observed to a similar extent in the eyes of PK, DSEK, and DMEK subjects even in the absence of any clinical sign of immune rejection. A further prospective longitudinal study will evaluate the effect of immune cells on long-term graft survival and the risk for graft rejection.
Outcomes of Pseudophakic, Phakic, and Triple DMEK
Authors: Moshiri Isabella , Karimi-Golkar Damian , Schrittenlocher Silvia , Cursiefen Claus , Bachmann Björn
Published: April 2021

Purpose:

To evaluate the outcome of phakic and pseudophakic eyes treated by Descemet membrane endothelial keratoplasty (DMEK) versus DMEK combined with cataract surgery (triple DMEK).

Methods:

Retrospective cohort study based on the prospective Cologne DMEK data base. This study is a single-center analysis of 62 eyes undergoing phakic (age mean ± SD 52 ± 6.43), 518 eyes undergoing pseudophakic (73.5 ± 8.57), and 557 eyes undergoing triple DMEK (67.93 ± 8.57). Outcome measures were changes in best spectacle-corrected visual acuity (BSCVA), central corneal thickness, endothelial cell density (ECD), rebubbling rates within the first year after surgery, and the need for cataract surgery within the first 2 years after phakic DMEK.

Results:

The preoperative BSCVA (mean ± SD; logarithm of the minimum angle of resolution) was 0.30 ± 0.22 in the phakic, 0.63 ± 0.45 in the pseudophakic, and 0.44 ± 0.30 in the triple DMEK group (P < 0.001), which changed to 0.09 ± 0.12, 0.14 ± 0.1, and 0.1 ± 0.1 (P < 0.001) 1 year after surgery, respectively. There was no difference in central corneal thickness (P = 0.929) and endothelial cell density (P = 0.606) 1 year postoperatively. Rebubbling rates in DMEK using SF6 20% for anterior chamber tamponade were not significantly different (P = 0.839). After phakic DMEK, 40% of eyes underwent cataract surgery within the second year. However, there was a high loss to follow-up in this group.

Conclusions:

Phakic and triple DMEK procedures tend to have a better 1-year BSCVA than pseudophakic DMEK, with no differences in all other parameters analyzed. However, patients from the pseudophakic DMEK group were older and already had worse BSCVA before surgery.
One-Year Front Versus Central and Paracentral Corneal Changes After Bowman Layer Transplantation for Keratoconus
Authors: Tourkmani Abdo K. , Mohammad Tariq , McCance Eleanor , Potts James , Ford Richard , Anderson David F.
Published: April 2021

Purpose:

To report the front corneal versus central and paracentral corneal changes after Bowman layer transplantation for keratoconus in a tertiary hospital in the United Kingdom.

Methods:

Five eyes of 5 patients receiving Bowman layer transplant for advanced keratoconus in Royal Gwent Hospital (Newport, United Kingdom) were included. Preoperative and postoperative visual acuity; Kmax; Kmean, and corneal cylinder in the front cornea, 4.5 mm central, and 6 mm central; and corneal thickness were analyzed.

Results:

Corneal flattening and reduction in corneal astigmatism was observed, more marked in the central and paracentral zone, allowing for improvement in best-corrected visual acuity with the aid of visual correction in 4 eyes.

Conclusions:

These results support previous data reporting Bowman layer transplantation as a useful strategy in the treatment of advanced keratoconus and suggest greater attention may be focused on central or paracentral corneal changes.
Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus
Authors: Dapena Isabel , van der Star Lydia , Groeneveld-van Beek Esther A. , Quilendrino Ruth , van Dijk Korine , Parker Jack S. , Oellerich Silke , Melles Gerrit R. J.
Published: April 2021

Purpose:

The aim of this study was to describe a new surgical technique for flattening the corneal curvature and to reduce progression in eyes with advanced progressive keratoconus (KC) by using Bowman layer (BL) onlay grafting and to report on the preliminary outcomes of this procedure.

Methods:

In this prospective interventional case series, 5 patients with advanced progressive KC underwent BL onlay grafting. After removal of the epithelium, a BL graft was placed and “stretched” onto the stroma, and a bandage lens was placed to cover the BL graft. In 1 case, BL onlay grafting could be performed immediately after ultraviolet corneal crosslinking; all other eyes were ineligible for ultraviolet corneal crosslinking. Best spectacle- and/or best contact lens–corrected visual acuity, refraction, biomicroscopy, corneal tomography, anterior segment optical coherence tomography, and complications were recorded at 1 week and at 1, 3, 6, 9, and 12 to 15 months postoperatively.

Results:

All 5 surgeries could be performed successfully. Average maximum keratometry went from 75 diopters (D) preoperatively to 70 D at 1 year postoperatively. All eyes showed a completely reepithelialized and a well-integrated graft. Best spectacle-corrected visual acuity improved at least 2 Snellen lines (or more) in 3 of 5 cases and best contact lens–corrected visual acuity remained stable, improving by 3 Snellen lines in case 1 at 15 months postoperatively. Satisfaction was high, and all eyes again had full contact lens tolerance.

Conclusions:

BL onlay grafting may be a feasible surgical technique, providing up to −5 D of corneal flattening in eyes with advanced KC.
Granulicatella adiacens Infective Endocarditis Treated With Teicoplanin and Ceftriaxone: A Case Report
Authors: Tang Min , Zhou Hongji , Zhang Ju , Peng Fengying , Sumayyah Golamaully , Jia Bei
Published: April 2021

We describe a case of infective endocarditis (IE) caused by Granulicatella adiacens in a patient who had fever for 4 months before admission. He had a complex medical history of active hyperthyroidism and schizophrenia, which might have misled the clinician in ignoring the existence of a serious infection like IE. A history of splenectomy and the likelihood of congenital cardiac valve deficiency were the possible underlying risk factors. His persistent leukocytosis perplexed our judgement in terms of resolution of infection and treatment efficacy, which was probably due to his splenectomy. C-reactive protein was the alternative laboratory indicator. Clinical and Laboratory Standards Institute criteria have not been established for the fastidious G. adiacens. Therefore, we referred to the viridans group streptococci and literature to evaluate antimicrobial susceptibility testing. We suggest that teicoplanin combined with ceftriaxone could serve as an effective therapy for IE caused by G. adiacens.
Seizure in Children Under Five Presenting With Pneumonia in a Critical Care Ward in Bangladesh: Prevalence, Associated Factors, and Outcome
Authors: Chisti Mohammod Jobayer , Sarker Shafiqul Alam , Shahunja KM , Shahid Abu Sadat Mohammad Sayeem Bin , Sharifuzzaman  , Hasan Md Imran , Nuzhat Sharika , Kabir Md Farhad , Afroze Farzana , Alam Tahmina , Shahrin Lubaba , Ahmed Tahmeed
Published: April 2021

Background:

Pneumonia is the leading infectious cause of deaths in children under 5 for the last few decades. Development of seizure in those children is common and associated with increased risk of deaths. We therefore investigated the prevalence, associated factors and outcome of seizure in children hospitalized with pneumonia.

Methods:

We conducted a retrospective chart analysis in the intensive care unit of the Dhaka Hospital of icddr,b. Children under 5 with World Health Organization (WHO) classified clinical (excluding seizure as 1 of the clinical diagnostics) and radiologic pneumonia, admitted to the intensive care unit at Dhaka Hospital of icddr,b between August 2013 and December 2017 were analyzed. We initially identified the children with pneumonia who had seizure. For comparison, we have taken 2 folds randomly selected controls from rest of the children with pneumonia having no seizure. Prevalence and outcome of children with pneumonia and seizure were measured. Factors associated with seizure in children with pneumonia compared with those without seizure were also identified. Seizure was characterized by sudden, violent, involuntary, and abnormal repetitive movements with or without loss or impairment of consciousness confirmed by attending physician.

Results:

Among a total of 4101 children with pneumonia, 514 (12.5%) had seizure. Compared with children with pneumonia alone children having pneumonia and seizure more often developed respiratory failure (18% vs. 3%,P < 0.001) and died (13% vs. 3%,P < 0.001) during hospitalization. In logistic regression analysis hypoxemia (95% CI: 1.59–3.17,P < 0.001), severe pneumonia (95% CI: 2.13–6.52,P < 0.001), severe sepsis (95% CI: 1.30–2.88,P = 0.001), and hypernatremia (95% CI: 5.31–10.93,P < 0.001) were found to be independent risk factors for seizure. On the contrary, children with pneumonia having seizure were less likely to have severe acute malnutrition (95% CI: 0.26–0.50,P < 0.001).

Conclusions:

Early identification of risk factors for seizure in children with pneumonia may be helpful for clinicians to promptly treat them and therefore may have potential to reduce deaths in those children especially in resource limited settings.
Coronavirus Disease 2019 in Pregnancy and Outcomes Among Pregnant Women and Neonates
Authors: Mark Elyse G. , McAleese Samuel , Golden W. Christopher , Gilmore Maureen M. , Sick-Samuels Anna , Curless Melanie S. , Nogee Lawrence M. , Milstone Aaron M. , Johnson Julia
Published: April 2021

Limited data are available about the outcomes of coronavirus disease 2019 (COVID-19) during pregnancy and risk of vertical transmission in exposed neonates. We reviewed studies published February 1, 2020, through August 15, 2020, on outcomes in pregnant women with COVID-19 and neonates with perinatal exposure. Among pregnant women with COVID-19, 181 (11%) required intensive care unit admission and 123 (8%) required mechanical ventilation. There were 22 maternal deaths. Most infections occurred in the third trimester. Among women who delivered, 28% had a preterm birth, and 57% had a Caesarean section. Sixty-one (4%) of 1222 neonates with reported testing had at least 1 positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. The most common symptom among neonates was respiratory distress (n = 126; 21%). There were 14 neonatal deaths, one of which occurred in a neonate with positive testing. Further study of COVID-19 in pregnant women and neonates, including standardized reporting of outcomes, testing and treatment protocols, is essential to optimize maternal and neonatal care.
A Case of Streptococcus intermedius Abscess Within a Malignant Neck Mass and Review of the Literature
Authors: Cummins Kaelyn C. , Lin Doris
Published: April 2021

Streptococcus intermedius is an organism found commensally in various mucosal sites. Over the past couple decades, it has been recognized as a cause of severe pyogenic infections in sites including the brain, liver, lung, head and neck. Here, we describe an uncommon case of S. intermedius infection in a patient with tonsillar squamous cell carcinoma and a metastatic neck mass with overlying postradiation skin changes. We also review the literature on this pathogen in cancer patients because it remains understudied despite its pathogenicity.
Scrub Typhus With Secondary Hemophagocytic Lymphohistiocytosis
Authors: Jayachandran Akshaya , Sundaresan Durgadevi , Pannu Ashok Kumar , Ahluwalia Jasmina , Chinnadurai Krishna Kumar , Saroch Atul
Published: April 2021

Scrub typhus is a rickettsial disease transmitted to humans by arthropods, via the bite of larval mites (chiggers). A young man, aged 18 years admitted with the fever of 5 days and altered sensorium for 1 day. The patient was evaluated for tropical illness with encephalopathy and multiorgan dysfunction syndrome. Patient serology was positive for scrub typhus and fulfill requisite criteria (hemophagocytic lymphohistiocytosis [HLH]-2004) for secondary HLH. He was managed as scrub typhus with secondary HLH and was given dexamethasone 4 mg three times a day. Patient condition improved and discharged with normal vital.
An Unusual Malady of the Bladder
Authors: Carroll Maggie , Hum Jamie , Pereira Marcus , Miko Benjamin , Pagan Carlos , D'Ovidio Frank , Cooper Kimberly , Arcasoy Selim M.
Published: April 2021

Malakoplakia is a rare disease most commonly found in the immunocompromised host and is diagnosed via tissue sampling. Delayed diagnosis is often the result of its nonspecific presentation. The patient described presented with dysuria, urinary urgency, and frequency in the setting of recurrent urinary tract infections despite antimicrobial therapy. After further evaluation including direct visualization with cystoscopy and tissue sampling, the patient was diagnosed with Malakoplakia of the bladder. With reduction in immunosuppression and prolonged antimicrobial therapy, the patient improved.
Immune Reconstitution Inflammatory Syndrome Presenting as Mycobacterium avium Complex Cervical Lymphadenitis and Mycobacterium kansasii Pulmonary Disease in an HIV-Infected Patient
Authors: Martinez Oscar , Jarrin Claudia
Published: April 2021

Immune reconstitution syndrome (IRIS) is a known complication from antiretroviral therapy that can occur in response to a pathogen, host, and/or treatment factors. Its presentation is heterogeneous and can pose a significant treatment challenge. Opportunistic infections presenting as IRIS can occur under settings, such as immunosuppression secondary to tumor necrosis factor inhibitors, untreated HIV starting antiretroviral therapy, hematopoietic stem cell, and solid organ transplant once immunosuppression is removed (HIV AIDS (Auckl). 2015;7:49–64).

The most common nontuberculous mycobacteria (NTM) to cause disease in advanced HIV is Mycobacterium avium complex. This pathogen can manifest during IRIS-causing focal disease, presenting as localized lymphadenopathy, or disseminated disease, with constitutional symptoms (Clin Microbiol Rev. 1996;9(2):177–215). Mycobacterium kansasii is the second most common NTM, to affect the lungs, and can also cause disseminated disease. We present a case of IRIS in an HIV-1–infected patient with evidence of 2 NTM-causing diseases.
Why Is a Child Not a Miniadult for Infections?
Authors: Chappell M. Tresa , Kelly Carrie , Rosenthal Ken S.
Published: April 2021

The presentation of an infectious disease in a child is likely to differ from an adult and will differ at different ages of the child. In addition to differences in immune response, there are significant differences in anatomy, physiology, metabolism, and behavior that affect susceptibility, course of disease, severity, and treatment. This is the first of a series of reviews that examine differences in disease presentation for different demographics. This short review will look at some of the parameters that ask, “Why is a child not a miniadult for infections?”
Early Use of Remdesivir in Patients Hospitalized With COVID-19 Improves Clinical Outcomes
Authors: Paranjape Neha , Husain Mir , Priestley Jennifer , Koonjah Yashila , Watts Christopher , Havlik Joseph
Published: April 2021

Background

Remdesivir treatment, like most antiviral drugs, is likely to be most effective when used early in the course of coronavirus disease 2019 (COVID-19). Optimal timing of remdesivir for the treatment of COVID-19 remains unclear.

Objectives

The aim of this study was to determine whether early treatment with remdesivir improves clinical outcomes: length of stay, need for mechanical ventilation, and death.

Methods

We conducted a retrospective observational study of patients hospitalized with COVID-19 who received remdesivir therapy within 10 days of symptom onset at a large health system in Georgia, United States.

Results

We identified a total of 475 patients. Initiation of therapy 3 days or less from first positive SARS-CoV-2 improved length of stay (15.7 days) compared with those started on therapy more than 3 days after a positive test (19.3 days) (P = 0.03). In the ≤3 day group, further reduction in length of stay was seen in those with lower oxygen requirement at baseline (P < 0.0001). Length of stay was lower in the ≤3 day group both with and without the use of corticosteroids (P = 0.0003). The odds of requiring mechanical ventilation were higher for the >3 day group compared with the ≤3 day group (odds ratio, 1.5; 95% confidence interval, 0.8–2.7), and the odds of death were higher for the >3 day group versus the ≤3 day group (odds ratio, 1.74; 95% confidence interval, 0.9–3.2).

Conclusions

Our data show that early treatment with remdesivir in patients hospitalized with COVID-19 shortened length of stay.
Research approaches for evaluating opioid sparing in clinical trials of acute and chronic pain treatments: Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials recommendations
Authors: Gewandter Jennifer S. , Smith Shannon M. , Dworkin Robert H. , Turk Dennis C. , Gan Tong J. , Gilron Ian , Hertz Sharon , Katz Nathaniel P. , Markman John D. , Raja Srinivasa N. , Rowbotham Michael C. , Stacey Brett R. , Strain Eric C. , Ward Denham S. , Farrar John T. , Kroenke Kurt , Rathmell James P. , Rauck Richard , Brown Colville , Cowan Penney , Edwards Robert R. , Eisenach James C. , Ferguson McKenzie , Freeman Roy , Gray Roy , Giblin Kathryn , Grol-Prokopczyk Hanna , Haythornthwaite Jennifer , Jamison Robert N. , Martel Marc , McNicol Ewan , L. Oshinsky Michael , Sandbrink Friedhelm , Scholz Joachim , Scranton Richard , Simon Lee S. , Steiner Deborah , Verburg Kenneth , Wasan Ajay D. , Wentworth Kerry
Published: April 2021

Randomized clinical trials have demonstrated the efficacy of opioid analgesics for the treatment of acute and chronic pain conditions, and for some patients, these medications may be the only effective treatment available. Unfortunately, opioid analgesics are also associated with major risks (eg, opioid use disorder) and adverse outcomes (eg, respiratory depression and falls). The risks and adverse outcomes associated with opioid analgesics have prompted efforts to reduce their use in the treatment of both acute and chronic pain. This article presents Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus recommendations for the design of opioid-sparing clinical trials. The recommendations presented in this article are based on the following definition of an opioid-sparing intervention: any intervention that (1) prevents the initiation of treatment with opioid analgesics, (2) decreases the duration of such treatment, (3) reduces the total dosages of opioids that are prescribed for or used by patients, or (4) reduces opioid-related adverse outcomes (without increasing opioid dosages), all without causing an unacceptable increase in pain. These recommendations are based on the results of a background review, presentations and discussions at an IMMPACT consensus meeting, and iterative drafts of this article modified to accommodate input from the co-authors. We discuss opioid sparing definitions, study objectives, outcome measures, the assessment of opioid-related adverse events, incorporation of adequate pain control in trial design, interpretation of research findings, and future research priorities to inform opioid-sparing trial methods. The considerations and recommendations presented in this article are meant to help guide the design, conduct, analysis, and interpretation of future trials.
Classification of chronic pain for the International Classification of Diseases (ICD-11): results of the 2017 international World Health Organization field testing
Authors: Barke Antonia , Korwisi Beatrice , Jakob Robert , Konstanjsek Nenad , Rief Winfried , Treede Rolf-Detlef
Published: April 2021

Because chronic pain has been poorly represented in the International Statistical Classification of Diseases and Related Health Problems (ICD) despite its significant contribution to the burden of disease worldwide, the International Association for the Study of Pain (IASP) developed a classification of chronic pain that was included in the ICD-11 version as “MG30” and approved by the World Health Assembly in 2019. The objective of this field test was to determine how well the classification of chronic pain works in the context of the ICD-11. A web-based survey using the WHO-FiT platform recruited 177 healthcare professionals from all WHO regions. After a training on coding chronic pain hosted by the IASP Web site, participants evaluated 18 diagnostic codes (lines) of the 2017 frozen version of the ICD-11 and 12 vignettes (cases) describing chronic pain conditions. Correctness, ambiguity, and perceived difficulty of the coding were compared between the ICD-11 and the ICD-10 and the applicability of the morbidity rules for the ICD-11 verified. In the line coding, 43.0% of correct chronic pain diagnoses assigned with the ICD-10 contrasted with 63.2% with the ICD-11. Especially in cases in which the chronic pain is regarded as the symptom of an underlying disease, the ICD-11 (63.5%) commanded more correct diagnoses than the ICD-10 (26.8%). The case coding was on average 83.9% accurate, only in 1.6% of cases any difficulty was perceived. The morbidity rules were applied correctly in 74.1% of cases. From a coding perspective, the ICD-11 is superior to the ICD-10 in every respect, offering better accuracy, difficulty, and ambiguity in coding chronic pain conditions.
Effect of intraoperative methadone vs other opioids on postoperative outcomes: a meta-analysis of randomized controlled studies
Authors: Cheriyan Thomas , Gaber Mohamed , Glenn Taylor , Latremouille John , Loy Kayla L. , Cheriyan Jerry , Dua Anterpeet , Singh Paramvir , Kumar Vikas , Omran Mohamed Ben
Published: April 2021

Recent randomized controlled trials comparing the efficacy between intraoperative methadone and other opioids on postoperative outcomes have been limited by their small sample sizes and conflicting results. We performed a meta-analysis on randomized controlled trials which investigated outcomes between methadone and an opioid control group. Primary outcome data included postoperative opioid consumption, number of patients who received postoperative opioids, time to first analgesic, and pain scores. Secondary outcomes included time to extubation and incidence of nausea, vomiting, and respiratory depression. Statistical analysis was performed using RevMan. A P < 0.05 was considered statistically significant. Nine studies comprising 632 patients were included. There was no statistically significant reduction in opioid consumption postoperatively between the groups. Forty-seven percentage of patients in the methadone group received a dose of opioid postoperatively compared with 55% in the other opioids control group, which was not statistically significant. (P = 0.25) There was no difference in average time to receiving first postoperative analgesic among the groups. Pain scores within 24 hours were significantly lower in the methadone group when compared with other opioids (8 studies, n = 622, −0.49 [−0.74, −0.23], P = 0.002). However, there was no difference between 24 and 72 hours. There was no difference among the groups with respect to extubation time, nausea, vomiting, or respiratory depression. This meta-analysis concludes that there is currently insufficient evidence for the use of intraoperative methadone, when compared with other opioids. Although there was a decrease in average pain scores with methadone when compared with controls at 24 hours, there was no difference between 24 and 72 hours.
Clinical and economic burden of prescribing tramadol and other opioids for patients with osteoarthritis in a commercially insured population in the United States
Authors: Silverman Stuart , Rice J. Bradford , White Alan G. , Beck Craig G. , Robinson Rebecca L. , Fernan Catherine , Schepman Patricia
Published: April 2021

In 2019, the American College of Rheumatology conditionally recommended tramadol and conditionally recommended against nontramadol opioids for patients with hip and knee osteoarthritis. Although tramadol is known to be less prone to opioid use disorders, little is known about the differing magnitude of negative clinical outcomes, health care resource utilization, and costs of tramadol relative to nontramadol opioids. Administrative claims records for commercially insured patients with osteoarthritis who were prescribed opioids were used to compare clinical and cost outcomes during a 3-year follow-up period by conducting a pre–post analysis and a matched case–cohort analysis. Data for 14,491 patients were analyzed: 4048 (28%) were initiated on tramadol, and 10,443 (72%) were initiated on nontramadol opioids. After matching, 4048 patients per cohort were analyzed. In each empirical analysis, tramadol patients did develop opioid use disorders; however, opioid use disorder rates were 3.5-fold higher in the nontramadol cohort (1.2% vs 4.2%). In addition, rates of other opioid-related clinical outcomes (falls, fractures, nausea, fatigue, and constipation) were also directionally lower among the tramadol cohort, although quantitatively similar (<5% difference) to the nontramadol cohort. Finally, in both analyses, the nontramadol cohort incurred higher levels of inpatient and emergency department visits and all-cause costs during the 3-year follow-up period. However, tramadol patients incur a higher incremental change (+$24,013) in costs relative to their pretreatment baseline compared with nontramadol (+$18,191). These real-world findings demonstrated lower risks with tramadol relative to other opioids, albeit risks and increased health care costs were present with tramadol, highlighting the need for further strategies to improve outcomes.