bluuebunny/crossref_metadata_2025 huggingface dataset:
A panel of diverse Pseudomonas aeruginosa clinical isolates for research and development
Authors: Lebreton Francois , Snesrud Erik , Hall Lindsey , Mills Emma , Galac Madeline , Stam Jason , Ong Ana , Maybank Rosslyn , Kwak Yoon I , Johnson Sheila , Julius Michael , Ly Melissa , Swierczewski Brett , Waterman Paige E , Hinkle Mary , Jones Anthony , Lesho Emil , Bennett Jason W , McGann Patrick
Published: November 2021

Objectives

Pseudomonas aeruginosa is a leading cause of community- and hospital-acquired infections. Successful treatment is hampered by its remarkable ability to rapidly develop resistance to antimicrobial agents, primarily through mutation. In response, WHO listed carbapenem-resistant P. aeruginosa as a Priority 1 (Critical) pathogen for research and development of new treatments. A key resource in developing effective countermeasures is access to diverse and clinically relevant strains for testing. Herein we describe a panel of 100 diverse P. aeruginosa strains to support this endeavour.

Methods

WGS was performed on 3785 P. aeruginosa isolates in our repository. Isolates were cultured from clinical samples collected from healthcare facilities around the world between 2003 and 2017. Core-genome MLST and high-resolution SNP-based phylogenetic analyses were used to select a panel of 100 strains that captured the genetic diversity of this collection. Antibiotic susceptibility testing was also performed using 14 clinically relevant antibiotics.

Results

This 100-strain diversity panel contained representative strains from 91 different STs, including genetically distinct strains from major epidemic clones ST-111, ST-235, ST-244 and ST-253. Seventy-one distinct antibiotic susceptibility profiles were identified ranging from pan-susceptible to pan-resistant. Known resistance alleles as well as the most prevalent mutations underlying the antibiotic susceptibilities were characterized for all isolates.

Conclusions

This panel provides a diverse and comprehensive set of P. aeruginosa strains for use in developing solutions to antibiotic resistance. The isolates and available metadata, including genome sequences, are available to industry, academia, federal and other laboratories at no additional cost.
Knowledge of use of antibiotics among consumers in Tanzania
Authors: Gabriel Salvador , Manumbu Loyce , Mkusa Omary , Kilonzi Manase , Marealle Alphonce Ignace , Mutagonda Ritah F , Mlyuka Hamu J , Mikomangwa Wigilya P , Minzi Omary
Published: November 2021

Background

Studies assessing consumers’ knowledge of the rational use of antibiotics are essential to understand the knowledge gap before intervention strategies are instituted.

Objectives

To assess the knowledge of rational use of antibiotics among consumers in Dar es Salaam, Tanzania.

Methods

A cross-sectional study assessing knowledge of rational use of antibiotics among 960 consumers was conducted in Dar es salaam in March 2021. Participants were consecutively enrolled from outpatient pharmacies in selected public and private hospitals and marketplaces in Ilala Municipality. Data were collected using the WHO-validated questions on knowledge of consumers of antibiotic uses.

Results

Overall, 196 (20.4%) and 503 (52.4%) participants demonstrated good knowledge of rational antibiotic use and conditions that can be treated with antibiotics, respectively. However, 678 (70.6%) responded that they stopped using antibiotics after dose completion, 515 (53.6%) would request the same antibiotic if it had helped to treat a similar condition in the past and 406 (42.3%) are willing to use the same antibiotic if a friend or family member used the medication previously to treat similar signs and symptoms. Besides, the following conditions were mentioned as being treatable with antibiotics: influenza (50.7%), sore throat (61.4%) and urinary tract infection (60.5%).

Conclusions

The majority of the consumers had poor knowledge of the rational uses of antibiotics and a moderate proportion had good knowledge of the conditions that are treatable with antibiotics. Those with a high level of education and with health insurance had good knowledge of rational uses of antibiotics.
Talking to Trolls—How Users Respond to a Coordinated Information Operation and Why They’re So Supportive
Authors: Linvill Darren L , Warren Patrick L , Moore Amanda E
Published: November 2021

This research explored how users interacted with inauthentic social media accounts with the goal of gaining insight into tactics employed by state-backed disinformation efforts. We combine hand coding with natural-language processing to measure the ways in which users talked with and about the accounts employed by the Russian-affiliated Internet Research Agency in the month before the 2016 U.S. Election. We find that user mentions were overwhelming supportive of the IRA accounts, belying the standard characterization of these personas as “trolls.” This pattern is particularly strong for the more ideological troll types, suggesting that a strategy of building homophilic connections with like-minded people was central to the IRA campaign. This strategy seems to work—on days that the personas’ mentions were more supportive, they received more engagement.
The Genetic Population Structure of Lake Tanganyika’sLatesSpecies Flock, an Endemic Radiation of Pelagic Top Predators
Authors: Rick Jessica A , Junker Julian , Kimirei Ismael A , Sweke Emmanuel A , Mosille Julieth B , Dinkel Christian , Mwaiko Salome , Seehausen Ole , Wagner Catherine E
Published: November 2021

Understanding genetic connectivity plays a crucial role in species conservation decisions, and genetic connectivity is an important component of modern fisheries management. In this study, we investigated the population genetics of four endemic Lates species of Lake Tanganyika (Lates stappersii, L. microlepis, L. mariae, and L. angustifrons) using reduced-representation genomic sequencing methods. We find the four species to be strongly differentiated from one another (mean interspecific FST = 0.665), with no evidence for contemporary admixture. We also find evidence for strong genetic structure within L. mariae, with the majority of individuals from the most southern sampling site forming a genetic group that is distinct from the individuals at other sampling sites. We find evidence for much weaker structure within the other three species (L. stappersii, L. microlepis, and L. angustifrons). Our ability to detect this weak structure despite small and unbalanced sample sizes and imprecise geographic sampling locations suggests the possibility for further structure undetected in our study. We call for further research into the origins of the genetic differentiation in these four species—particularly that of L. mariae—which may be important for conservation and management of this culturally and economically important clade of fishes.
Interpretation in Police Stations: Lawyers’ Perspectives on Rights and Realities
Authors: Conway Vicky , Daly Yvonne , McEvoy Gearóidín
Published: November 2021

Limited attention has been paid to the realization of the right to interpretation in the police station. What has been done often focuses on the police or the interpreter experience. We seek to address this lacuna by focusing on the extent to which the right to interpretation is realized in Ireland. We start by outlining the nature of the right at international and European levels, and exploring the reasons why the right is so important. We consider how this has been implemented in Ireland, and note how even on paper there are significant, fundamental concerns as to how the effectiveness of the right is achieved. We then present findings from semi-structured interviews with over 40 criminal defence solicitors in Ireland, with experience of attending police interviews. The findings show that solicitors have concerns about the process of securing interpreters, the quality of the work, their independence, their understanding of their role, the overall impact on the process and the urgent need for training. It is abundantly clear that the right cannot be effectively realized under the current system in Ireland, despite the Directive on Interpretation being in effect there. Further, we note that solicitors are often uncertain and unclear on the extent of the right and what they can ask for. This means that those who are defending the rights of the detainee are unlikely to challenge breaches as they occur. The right to interpretation is clearly deeply neglected and ineffective in Ireland.
Review of Mallika Kaur’s Faith, Gender, and Activism in the Punjab Conflict: The Wheat Fields Still Whisper
Authors: Malhotra Khushdeep Kaur
Published: November 2021

This manuscript reviews Dr Mallika Kaur’s powerful book which brings to light the stories of people who despite grave personal harms, continued to resist the Indian state’s violent response to Punjab’s armed insurgency in the 80s and 90s. Their meticulous documentation of the state’s many excesses, preservation of ‘forgotten’ histories and determination to take on a powerful state even as it hunted them down, has made it possible to not only counter India’s narrative of ‘terror’ in Punjab, but bring the state to justice. In recovering the stories of Punjab’s human rights defenders, and ordinary citizens who did extraordinary things, Kaur has not only enabled them to be preserved for posterity but also contributed perhaps one of the most important and overlooked chapters to Punjab’s history. But for her work, our understanding would remain bound by convenient narratives of Punjab and its conflict as a battle confined between the state and armed ‘rebels’; when in fact it spilled into the everyday lives of ordinary citizens who became the state’s unsuspecting targets and paid the price for its misadventures. The writing is brave not only for the stories it narrates, but because Kaur’s refreshingly honest and direct voice makes it clear why the personal is political, and why silence is not an option in an increasingly unjust world.
A Statistical Test for Legal Interpretation: Theory and Applications
Authors: Nyarko Julian , Sanga Sarath
Published: November 2021

Many questions of legal interpretation hinge on whether two groups of people assign different meanings to the same word. For example: Do 18th- and 21st-century English speakers assign the same meaning to commerce? Do judges and laypersons agree on what makes conduct reasonable? We propose a new statistical test to answer such questions. In three applications, we use our test to (1) quantify differences in the meanings of specialized words from civil procedure, (2) identify statistically significant differences between judges and laypersons’ understandings of reasonable and consent, and (3) assess differences across various effort standards in commercial contracts (phrases like best effort and good faith effort). Our approach may be readily applied outside the law to quantify semantic disagreements between or within groups. (JEL C10, C12, C55, K12, K41).
Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy with a micro-multileaf collimator for brain metastasis in the primary motor cortex
Authors: Matsuda Ryosuke , Hasegawa Masatoshi , Tamamoto Tetsuro , Ochi Tomoko , Miyasaka Toshiteru , Inooka Nobuyoshi , Hontsu Shigeto , Miura Sachiko , Takeshima Yasuhiro , Tamura Kentaro , Yamada Shuichi , Nishimura Fumihiko , Nakagawa Ichiro , Motoyama Yasushi , Park Young-Soo , Nakase Hiroyuki
Published: November 2021

This study aimed to assess the clinical outcomes of linear accelerators (linac)-based, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for brain metastasis in the primary motor cortex (BMPMC). Thirty-five consecutive patients with BMPMC who were treated by linac-based SRS or fSRT between January 2012 and March 2020 were analyzed. BMPMC was defined as a tumor located in the precentral gyrus on gadolinium-enhanced magnetic resonance imaging (MRI) and T2-weghted imaging (T2WI). In total, 35 patients with 37 metastases were analyzed. The median follow-up time was 13 (range: 1–97) months. The tumor volume was 0.05–26.5 (median: 0.62) cm3. All patients were treated with SRS or fSRT using 35 Gy with 7 Gy per fraction daily. The median survival time (MST) was 16.9 months. The pretreatment KPS and RPA class significantly differed in terms of MST on the log-rank tests. Seven symptomatic patients had hemiparesis before SRS or fSRT. All symptomatic patients, except one with facial paresis and one who died within 3 months, experienced improvement at a 3 month follow-up. None of the patients presented with persistent radiation injury at the final follow-up. Two patients presented with grade 3 radiation-related central nervous system necrosis, which was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. In BMPMC, SRS and fSRT had good tumor control and did not cause serious complications. Therefore, they are suitable treatment options with an acceptable safety profile.
B.1.1.7 Variant Outbreak in an Air Force Military Base—Real-World Data
Authors: Nitecki Maya , Savitsky Bella , Akavian Inbal , Yakhin Alexey , Narkiss Tamar , Michael Yossi Ben , Shapira Shachar , Friedensohn Limor
Published: November 2021

Objective

To assess the clinical features and infectivity of variant B.1.1.7 among healthy young adults in a military setting.

Materials and Methods

Positive cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a single military base (March 23, 2020 and February 16, 2021) were included. An epidemiological investigation conducted via phone included questions regarding symptoms, exposure history, smoking status, list of contacts, and recently visited places. Symptoms surveyed included fever, cough, shortness of breath, sore throat, loss of smell or taste, gastrointestinal symptoms (GI), headache, chest pain, and constitutional symptoms. Cases were divided before B.1.1.7 first reported case in Israel (December 23, 2020) (period 1) and after its identification (period 2). Symptom distribution and the risk of a contact to be infected were compared between the periods, using a chi-square test, and a negative binominal regression model, respectively.

Results

Of 293 confirmed cases, 89 were reported in the first period and 204 in the second. 56.0% were men with a median age of 19.5 years (interquartile range 18.6-20.5). GI symptoms, loss of taste or smell, headache, fever, and chills were more prevalent in the first period (P < .001, P = .026, P = .034, P = .001, and P < .001, respectively), while fatigue was more common in the second period (P = .008). The risk of a contact to be infected was three times higher in the second period (relative risk  = 3.562 [2.414-5.258]).

Conclusion

An outbreak of SARS-CoV-2 in young healthy adults, during a period with high national-wide B.1.1.7 variant prevalence, is characterized by decreased prevalence of fever, loss of taste or smell and GI symptoms, increased reports of fatigue, and more infected contacts for each index case.
Vacuolar H+-pyrophosphatase HVP10 enhances salt tolerance via promoting Na+ translocation into root vacuoles
Authors: Fu Liangbo , Wu Dezhi , Zhang Xincheng , Xu Yunfeng , Kuang Liuhui , Cai Shengguan , Zhang Guoping , Shen Qiufang
Published: November 2021

Vacuolar H+-pumping pyrophosphatases (VPs) provide a proton gradient for Na+ sequestration in the tonoplast; however, the regulatory mechanisms of VPs in developing salt tolerance have not been fully elucidated. Here, we cloned a barley (Hordeum vulgare) VP gene (HVP10) that was identified previously as the HvNax3 gene. Homology analysis showed VP10 in plants had conserved structure and sequence and likely originated from the ancestors of the Ceramiales order of Rhodophyta (Cyanidioschyzon merolae). HVP10 was mainly expressed in roots and upregulated in response to salt stress. After salt treatment for 3 weeks, HVP10 knockdown (RNA interference) and knockout (CRISPR/Cas9 gene editing) barley plants showed greatly inhibited growth and higher shoot Na+ concentration, Na+ transportation rate and xylem Na+ loading relative to wild-type (WT) plants. Reverse transcription quantitative polymerase chain reaction and microelectronic Ion Flux Estimation results indicated that HVP10 likely modulates Na+ sequestration into the root vacuole by acting synergistically with Na+/H+ antiporters (HvNHX1 and HvNHX4) to enhance H+ efflux and K+ maintenance in roots. Moreover, transgenic rice (Oryza sativa) lines overexpressing HVP10 also showed higher salt tolerance than the WT at both seedling and adult stages with less Na+ translocation to shoots and higher grain yields under salt stress. This study reveals the molecular mechanism of HVP10 underlying salt tolerance and highlights its potential in improving crop salt tolerance.
On The Classification Of Certain 1-Connected 7-Manifolds And Related Problems
Authors: Wang Xueqi
Published: November 2021

We study the classification of closed, smooth, spin, 1-connected 7-manifolds whose integral cohomology ring is isomorphic to $H^*(\mathbb{C}P^2\times S^3)$. We also prove that if the integral cohomology ring of a closed, smooth, spin, 1-connected 7-manifold is isomorphic to $H^*(\mathbb{C}P^2\times S^3)$ or $H^*(S^2\times S^5)$, this 7-manifold admits a Riemannian metric with positive Ricci curvature.
Averages of the Möbius Function on Shifted Primes
Authors: Lichtman Jared Duker
Published: November 2021

It is a folklore conjecture that the Möbius function exhibits cancellation on shifted primes; that is, $\sum_{p{\,\leqslant} X}\mu(p+h) \ = \ o(\pi(X))$ as $X\to\infty$ for any fixed shift h > 0. This appears in print at least since Hildebrand in 1989. We prove the conjecture on average for shifts $h{\,\leqslant} H$, provided $\log H/\log\log X\to\infty$. We also obtain results for shifts of prime k-tuples, and for higher correlations of Möbius with von Mangoldt and divisor functions. Our argument combines sieve methods with a refinement of Matomäki, Radziwiłł and Tao’s work on an averaged form of Chowla’s conjecture.
P029 Assessment of diagnosis delay during enthesitis related arthritis
Authors: Bettaieb Hiba , Ferjani Hanene , Ben Nessib Dorra , Triki Wafa , Maatallah Kaouther , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Enthesitis related arthritis (ERA) is a distinct subgroup of juvenile arthritis characterized by male predominance and adolescent onset. Though, ERA patients still experience long diagnosis delays. This may lead to articular damage and functional disability. The aim of this study was to quantify the lag time between ERA symptoms onset and diagnosis and to evaluate its impact on disease activity, functional disability and structural damage.

Methods

A retrospective monocentric study was carried out on ERA patients. Diagnosis delay was collected from patients’ medical files. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional disability and structural damage were evaluated by Bath Ankylosing Spondylitis Fonctional Index (BASFI) and Bath Ankylosing Spondylitis Radiology Index (BASRI) respectively. Data were analyzed using the SPSS statistical package. A p-value < 0.05 was considered significant.

Results

Thirty-four patients with a mean age of 23.8 ± 7.5 years were included. Male to female sex ratio was 3.85. Mean age at disease onset was 12 ± 2.6 years. Median disease duration was 108 months [12–408]. Median ERA diagnosis delay was 10 months [3–108]. Median ESR and CRP were 35 mm/h [8–90] and 20 mg/l [1–70] respectively. Median BASDAI score was 4.7 [1–9.7]. Median BASFI and BASRI scores were 4.6 [1.9–10] and 10 [2–16] respectively. Coxitis was found in 38.2% of cases.

On statistical analysis, significant positive correlation was found between ERA diagnosis delay and ESR (P = 0.03, r = 0.69) and CRP (P = 0.05, r = 0.456) respectively.

No link was noted between ERA diagnosis delay and these parameters: gender (P = 0.58), age at disease onset (P = 0.68), occurrence of coxitis (P = 0.66), BASFI (P = 0.08), BASDAI (P = 0.45) and BASRI (P = 0.12).

Conclusion

ERA patient’s journey was long in our study. Longer delays were associated with higher ESR and CRP levels. Further studies are required to confirm our results.
P050 Consensus based practice guidelines for the management and treatment of Juvenile familial Mediterranean fever: the Egyptian College of Paediatric Rheumatology initiative
Authors: Salah S , Lotfy H , Hassan M , Abdulhady H , Salah H , El Gaafary M , Abd El-Latif E , Farag Y , Eissa M , Esam Maher S , Radwan A , El-Shanawany Amira T , Medhat B M , El Mikkawy D , Mosa D M , El Deriny G , Mortada M , Osman N S , Fouad N A , Elkaraly N E , Mohamed S S , Tabra S , Hassan W A , Amer Y , Nasef S I , El Miedany Y
Published: November 2021

Background

Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease, with the highest prevalence amongst Mediterranean countries including Egypt (where there is high carrier rate of MEFV gene), characterized by recurrent attacks of fever and polyserositis. Mutations in the MEFV gene encoding pyrin has been associated with the disease, which causes exaggeration of the inflammatory response through uncontrolled interleukin production. Issuing updated treatment recommendations are vital for the treating healthcare professionals to get well acquainted with its diagnosis & treatment. To produce consensus-based recommendations to guide the early diagnosis, management and follow-up of patients with FMF.

Methods

The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by the core team.

A qualitative synthesis of scientific evidence based on systematic review and clinical experience was conducted to compile evidence for the diagnosis and management of FMF.

A consensus process was conducted among the expert panel to generate the final recommendations and grade their strength.

3 rounds of Delphi process were carried out.

Results

Following 3 Delphi rounds, recommendations were developed for: early diagnosis, who to treat, treatment targets, genetic testing and its interpretation in association with clinical presentation, treatment of FMF and dealing with acute attacks, monitoring of management, identify treatment response, systemic affection, persistent attacks or inflammation, resistant cases, protracted symptoms, as well as remission status.

Algorithm for patients’ diagnosis and management is provided.

The final document comprises 12 recommendations, each presented with its degree of agreement (0–10), Level of agreement, grade of recommendation and rationale. The degree of agreement was >7/10 in all instances.

Conclusion

This guideline provides comprehensive approach to the accurate diagnosis and effective management/monitoring of FMF. It also represents a model for the incorporation of medical genetics practice into the more traditional domains of general medicine.
P058 Epidemiological clinical, etiologic spectrum and follow-up results of uveitis in children: a single center experience
Authors: Messadi W , Salmi A , Guemri N , Cherif N
Published: November 2021

Background

Uveitis refers to the inflammation of the vascular tunic of the eye. This inflammation varies greatly in its clinical expressions and etiologies and is often a majordiagnostic challenge for physicians. These data cover symptoms, clinical examination results, complications, etiologies and treatments

Methods

A retro-prospective monocentric study was carried out on 22patients hospitalized in the pediatric department of the issaadhassani hospital of Algiers during the period of January 2017 to December 2021.

Results

The sex ratio is 1,2. Their average age was 8 years (4–15Y). Most of thepatients consulted for the three cardinal signs of uveitis: 81% for a decrease in visual acuity, 59% for redness, and 43% for ocular pain. Uveitis was bilateral in 55% of the cases. Inanatomical localization, 45,5% of patients had total uveitis, 27% had anterior uveitis, and 18% had intermediate uveitis, and 9% had anterior and intermediate uveitis. An etiologic diagnosis was made in 32% of the cases. The most frequent causes were inflammatory. Treatments consisted of local corticosteroid therapy for all thepatients, a general corticoid treatment for all of the patients, associated with an immunosuppressive treatment for 50% and biologic anti TNF α treatment (adalimumab) for23% cases. A good evolution after treatment was noted among patients with visual acuity <3/10 with a substantial decrease from 67% to 2%.77.5% are in remission, 13.5% are improving and 9% are in relapse the duration of the follow-up is 1 ½ years with intervals of 2 months and 5 years.

Conclusion

The results of the current study are generally compatible with the literature. however. The percentage of etiologies covered remains a point to improve, The pooled prevalence of uveitis in pediatric rheumatic diseases widely varied based on the underlying disease requiring more investigations in different subtypes of rheumatic diseases. The biologic medications, especially Adalimumab are the most effective treatments for uveitis in pediatric rheumatic diseases; however, a combination of the safe, available alternatives is preferred to achieve the most desirable treatment response.
P071 Osteoid osteoma in children: About 15 cases
Authors: Khernane N , Fortas S , Makhloufi M M , Boussaha T
Published: November 2021

Background

Osteoid osteoma (OO)also called osteoblastoma, if the localization is in the spine, is a benign osteoblastic tumor of variable clinical expression, depending on the location of the lesion. It represents 2% to 3% of bone tumours and 15% of benign bone tumours in children. It affects mainly older children and adolescents and most often occurs in the lower limb, especially the femur. The diagnosis is radio-clinical.

The aim of this study is to demonstrate the effectiveness of surgical removal of the tumor, the therapeutic difficulty in certain osteoarticular localizations and finally the radio-clinical evolution after surgery.

Material & methods

We report the radio-clinical outcomes of a series of 15 children (4 girls/11 boys; aged of 03–14 years) with OO operated in our department, over a period of 08 years (2011–2019).

Results

The OO is located in most of cases of the lower limbs: acetabulum (1 case); femoral neck (3 cases); femoral diaphysis (2 cases); tibial diaphysis (4 cases); distal metaphysis of the tibia (1 case); talus (1 case) and in the spine (3 cases: vertebral body of T3, the posterior arch of T12 and the sacrum S3). Nocturnal pain yielding to aspirin, was the main symptom. It was associated with lameness when walking in patients with location of OO in the lower limbs. Diagnosis was delayed in patients with localization of OO in the spine (after 3 years) and in the talus (after 2 years). Imaging (standard Rx, CT scan and MRI) allowed the diagnosis of OO in all cases (nidus and cocarde image) and assessed the loco-regional impact (compression of the spinal canal in the sacral location; eccentricity of the femoral epiphysis, in the acetabular location, scoliosis in the spinal location).

Thirteen children received surgical treatment under fluoroscopic guidance, which consisted of:

A surgical abstention was decided in 2 cases: an inaccessible location at the bottom of the acetabulum and the T3 thoracic vertebral body localization in a 6-year-old girl.

12 operated children have good outcomes. However, 03 children experienced post-therapy problems: lumbar pain radiating towards the left thigh in the girl with sacral location (S3) despite the large laminectomy; a relapse 7 months later in the child with the femoral neck localization;

A valgus misalignment of the right knee after removal of the OO of the proximal metaphysis of the tibia with a relapse 3 months later.

Conclusion

OO is a rare, benign tumor. However, certain locations can lead to diagnostic difficulties, loco-regional, organic and functional repercussions and certain constraints on their therapeutic management. Modern imaging helps to improve the care of these patients, both in terms of early diagnosis (scintigraphy, CT scan and MRI) and therapeutic precision (photo-coagulation, radiofrequency ablation).
P072 Lobstein's disease: about 12 observations
Authors: Jomaa Olfa , Mahbouba Jguirim , Saoussen Zrour , Ismail Bejia , Monji Touzi , Bergaoui Naceur
Published: November 2021

Background

Osteogenesis imperfecta (OI), or Lobstein's disease, is a rare inherited disorder characterized by bone fragility and low bone mass. The symptoms are diverse, with varying severity of skeletal signs and inconstant extra-skeletal signs. Type 1 is the most frequent form (about 60% of cases). Our objective is to describe the different clinical pictures hospitalized in our department during the last 15 years.

Patients and methods

This is a retrospective descriptive study including 12 patients followed for OI, hospitalized in the rheumatology department of Fattouma Bourguiba University Hospital Monastir TUNISIA between 2006 and 2019. The records were collected and analyzed.

Results

There were 9 boys and 3 girls with a mean age of 14.9 ± 8.6 years. Consanguinity was reported in 25% of cases. The chief reason for consultation was recurrent fractures (75%), blue sclera (16.7), and bone deformation (8.3%). The average number of anterior fractures was 5, with low-energy trauma as the mechanism in all cases. Similar cases in the family were noted in 41.6% of cases, in siblings in 25% of cases. The mean age of the first fracture was 4.41 ± 3.2 years. The most frequent fracture sites were respectively: femur (7/12), leg (6/12), tibia (3/12), humerus (4/12), ankle (2/12), and forearm (2/12). The deformity was noted in 58.3% of cases: lumbar kyphosis (2), exaggerated dorsal kyphosis (2), bracketed femurs (2), and anarchic deformity of 2 lower limbs (1). Dentinogenesis imperfecta was found in 8.3% of cases, while ENT examination revealed a conductive and sensorineural hearing loss in 2 patients each. The main radiological abnormalities were diffuse bone demineralization in 9 patients, thinning of the cortical bone in 5 patients, vertebral fractures in 3 patients, and fracture in 2 patients. Bone densitometry showed a mean Z-score of 3.49 ± 1.4 in the lumbar spine. The mean blood calcium level was 2.38 ± 1.15, alkaline phosphatase was elevated in all cases with a mean of 756 ± 624.9, and vitamin D levels were deficient in all cases with a mean of 22.75 ± 5.3. In addition to vitamin-calcium supplementation, all patients received intravenous pamidronate at a dose of 9 mg/kg/year with an average of 6 courses. The main side effects noted at the time of infusion were abdominal pain, polyarthralgia and asthenia (1 patient), chest pain (1 patient), and fever and chills (1 patient). Control bone densitometry showed a mean Z score of 1.81 ± 1.2 in the lumbar spine.

Conclusions

Osteogenesis imperfecta is a severe disease with a risk of serious complications t. In the absence of etiological treatment, symptomatic management must be both early and multidisciplinary.
P077 Ultrasound features of a traumatic hip pain in paediatric population
Authors: Bettaieb Hiba , Affess Hassene , Ferjani Hanene , Maatallah Kaouther , Ben Nessib Dorra , Triki Wafa , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Atraumatic hip pain in children is a serious condition that may require urgent investigations. Conventional radiographs are often normal in early stage of the diseases. However, further imaging techniques such as hip ultrasonography (US) are needed. The main objective of this study is to describe Hip ultrasound findings in patients with atraumatic hip pain.

Methods

We conduct a retrospective monocentric study. Children with atraumatic hip pain and undergoing joint ultrasound were included. Sociodemographic, clinical and biological characteristics were collected. The data were analyzed using the SPSS statistical package. Results:

Thirty patients (21 boys and 9 girls) were enrolled. The male to female sex ratio was 2.3. Mean age at disease onset was 9.1 ± 4.6 [1.3–16]. Median diagnosis delay from symptoms onset was 1.2 months [0.2–48]. Chief complaints were as following: 80% of inflammatory hip pain (n = 24), 20% of mechanical hip pain (n = 6) 76.7% of limping (n = 23), 23.3% of functional impotence (n = 7) and 23.3% of fever (n = 7). Physical examination noted a pain on passive joint mobilization and restriction of hip movement in 90% (n = 27) and 54% (n = 18) of cases respectively. A biologic inflammatory syndrome was found in 66.6% of cases (n = 20). Median ESR and CRP were 30 mm/h [2–101] and 4.5 mg/l [1–38] respectively. Hip X-ray was abnormal in 46.6% (n = 14) of cases. All patients had hip ultrasound. US findings were as following: 80% (n = 24) of joint effusion, 50% (n = 15) of synovial thickening, 36.7% (n = 11) of synovitis and 23.3% (n = 7) of positive power Doppler signal. Hip Ultrasound was normal in 13.3% (n = 4) of cases. Causes of hip pain were in decreasing order of frequency: septic arthritis (n = 10), juvenile idiopathic arthritis (n = 10), transient synovitis (n = 7), osteoid osteoma (n = 2) and osteosarcoma (n = 1).

Conclusion

Hip Ultrasonography is a noninvasive and useful screening technique for the management of atraumatic hip pain in children. Though, imaging features are often various and nonspecific. Radiologists should be more familiar with sonographic anatomy of infant hip.
P087 Polyarteritis nodosa: a case report
Authors: Azirar A , Ghannam A , Elaouli A , Rkain M , Benaajiba N , Babakhouya A
Published: November 2021

Background

Polyarteritis nodosa is a necrotizing vasculitis of small and medium caliber arteries. Rarely described in children, its pathophysiology is complex and remains poorly elucidated. Two main forms were described in the literature: cutaneous and visceral.

Material and results

We report the cases of two boys, aged of 7 and 11 years old. They had a history of recurrent sore throat with a recurrent aphthosis in the 11-year-old child. Both boys presented with polyarthralgias, myalgias, polymorphous skin lesions made of livedo reticularis with subcutaneous nodosa on the lower limbs in the first child and distal necrosis of the toes with oedema of the lower limbs in the second. Patients suffered also of cough evolving in a context of alteration of the general state made of fever and asthenia. A biological inflammatory syndrome was present in both children and the skin histology confirmed periarteritis nodosa. The evolution was marked by the disappearance of arthralgias and myalgias after a corticosteroid-based treatment with progressive dose reduction until minimal effective dose.

Conclusion

The diagnosis of Polyarteritis nodosa should be made in any child presenting with the following signs: fever, altered general condition, myalgias, arthralgias and skin manifestations. The prognosis is usually benign but long-term surveillance is necessary.
P088 Prolonged fever in a boy revealing Takayasu disease: a case report
Authors: Asbik O , Babakhoya A , Rkain M , El Ouali A , Ghanam A , Benajiba N
Published: November 2021

Background

Takayasu's arteritis (TA) is a chronic inflammatory vasculitis of unknown origin. It affects the large vessels, especially the aorta, its main branches, and the pulmonary arteries. It begins acutely in children with severe general manifestations. The diagnosis of TA remains a challenge to clinicians due to many reasons such as its rarity, its great clinical polymorphism, and the lack of specific biological criteria.

Case report

A 13-years old boy with no pathological history, was admitted for prolonged fever with intermittent abdominal pain. The clinical examination has found a conscious boy, febrile with a BP of 130/90mmhg, a normal heart rate, and stable respiratory function. The cardiovascular examination noted a decrease in pedal pulses, without signs of ischaemia or necrosis, and the cardiac auscultation was normal. Examination of the lymph node areas has shown upper and left later cervical adenopathy measuring 1.7 cm in long axis, mobile, and painless. All joints were free. The complementary biological workups revealed an inflammatory syndrome (ESR: 120 mm, fibrinogen: 5 g/l, microcytic hypochromic anaemia at 9 g/dl, ferritin: 1051, low serum iron: 11µg/dl and thrombocytosis: 692 000 elements/l). Chest X-ray showed a dilated aortic button. A thoracic angioscan revealed a peri-aortitis more evident at the level of the emergence of the mesenteric artery with a pseudo-aneurysmal aspect and arteritis of the right primary carotid artery. Echocardiography was performed and showed a dilated aspect of the aorta with irregular wall. Renal ultrasound was normal. The diagnosis of Takayasu disease was made on the basis of clinical biological and essentially radiological arguments according to the diagnostic criteria of the American College of Rheumatology. The patient was treated with corticosteroid (prednisone: 2 mg/kg/d) for one month then then gradually reduced doses The disease course was marked by several relapses and the patient was then treated with mycophenolate mofetil (cellcept).

Conclusion

Takaysu's disease is a chronic inflammatory vasculitis of unknown origin, which affects the large- vessels, mainly the aorta, its main branches, and the pulmonary arteries; but it remains rare in children and its treatment is not well codified.
P093 Algodystrophy in children: a case report
Authors: Nait Abdallah M S , Boutalbi N , Boulekhssaim I , Kachi A , Boutabia A W , Bouchair N
Published: November 2021

Background

Algodystrophy is an entity very often unrecognized by pediatricians. The evolution is readily dragging and disabling in the absence of early and coordinated care. The Objective: Based on a case observed in a 10-year-old boy, the authors recall the main characteristics of the syndrome, guiding the practitioner to make the diagnosis, and implement appropriate and early therapy.

Observation

A 10-year-old boy with no previous medical history, presenting with neuropathic-like pain in the wrist and the hand that started a month ago without any triggers. Clinical exam noted functional impotence, a whole limb tremor, hyperesthesia as well as allodynia.

The patient's hand is swollen and warm with a claw-like appearance.

The rest of the body exam is normal.

The laboratory markers and x-rays of the whole limb are normal. Bone scintigraphy confirms the diagnosis of wrist algodystrophy. The treatment combining corticosteroids, functional rehabilitation, and psychotherapy allowed a favorable outcome with no sequelae.

Conclusion

The diagnosis of algodystrophy remains too often unrecognized, and its management is sometimes inadequate. Early diagnosis and treatment improve the prognosis.
P097 Diagnostic dilemma of acquired non-traumatic spinal deformation: Pott's disease; histiocytosis or psoriatic rheumatism? About a case
Authors: Fadila Bendaoud , Hassen Mouffouk , Sara Ouzani , Saida Brahmi
Published: November 2021

Background

Non-traumatic acquired spinal deformities represent a separate entity within the axial pathologies in children. Their causes are variable (neurological, muscular, infectious, especially Pott's disease, inflammatory or tumoral).

The etiological diagnosis can be clinically oriented by pain, medical history, especially rheumatic. The contribution of the CT scan is crucial, as it localizes the lesion, specifies its nature, but above all it helps the histological diagnosis by guided biopsies.

Our case illustrates the difficulties in diagnosing the aetiology of spinal acquired deformity in a girl with a multi-evocative context.

Observation

A 14 years-old girl complains for a few months of a dorso-lumbar spinal pain and a vicious attitude. Her medical history includes femoral thrombophlebitis and psoriasis. She had no trauma or fever.

Clinically, the general state is preserved, with no local inflammatory signs, a kyphotic attitude with an analgesic lumbar support was noted. The rest of the locomotor exam was normal.

CT scan shows cancellous body geodes with a double mirror.

Discussion

Acquired spinal deformities are always secondary to general disease. The fever may point to bacterial infections, especially tuberculosis (Pott's disease), but also non-infectious causes such as a rheumatic disease.

For our patient, psoriasis argues for the latter possibility. However, the rarity of isolated disco-vertebral involvement and the severity of the lytic lesions are against this diagnosis. The histopathological exam showed an eosinophilic granuloma, confirming the histiocytosis X diagnosis. The cortico-response strengthen the diagnosis.

The course was marked by the bone remodeling with the posture correction.

Conclusion

A clinical, radiological, and histological analysis allow the etiological orientation in front of acquired spinal deformity.
Risk of chronic kidney disease in patients with obstructive sleep apnea
Authors: Beaudin Andrew E , Raneri Jill K , Ahmed Sofia B , Hirsch Allen A J Marcus , Nocon Andrhea , Gomes Teresa , Gakwaya Simon , Series Fréderic , Kimoff John , Skomro Robert P , Ayas Najib T , Hanly Patrick J
Published: November 2021

Study Objectives

Chronic kidney disease (CKD) is a global health concern and a major risk factor for cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) may exacerbate this risk by contributing to the development of CKD. This study investigated the prevalence and patient awareness of the risk of CKD progression in individuals with OSA.

Methods

Adults referred to five Canadian academic sleep centers for suspected OSA completed a questionnaire, a home sleep apnea test or in-lab polysomnography and provided blood and urine samples for measurement of estimated glomerular filtration rate (eGFR) and the albumin:creatinine ratio (ACR), respectively. The risk of CKD progression was estimated from a heat map incorporating both eGFR and ACR.

Results

1295 adults (42% female, 54 ± 13 years) were categorized based on the oxygen desaturation index (4% desaturation): <15 (no/mild OSA, n = 552), 15−30 (moderate OSA, n = 322), and >30 (severe OSA, n = 421). After stratification, 13.6% of the no/mild OSA group, 28.9% of the moderate OSA group, and 30.9% of the severe OSA group had a moderate-to-very high risk of CKD progression (p < .001), which was defined as an eGFR <60 mL/min/1.73 m2, an ACR ≥3 mg/mmol, or both. Compared to those with no/mild OSA, the odds ratio for moderate-to-very high risk of CKD progression was 2.63 (95% CI: 1.79−3.85) for moderate OSA and 2.96 (2.04–4.30) for severe OSA after adjustment for CKD risk factors. Among patients at increased risk of CKD progression, 73% were unaware they had abnormal kidney function.

Conclusion

Patients with moderate and severe OSA have an increased risk of CKD progression independent of other CKD risk factors; most patients are unaware of this increased risk.
Age and Workplace Deviance: A Meta-Analytic Test and a Trait-Based Examination of Why Older Employees Engage in Less Workplace Deviance
Authors: Pletzer Jan Luca , Oostrom Janneke K , Voelpel Sven C
Published: November 2021

In the current meta-analysis, we examine the relation between age and workplace deviance, and find a small but significant negative correlation (ρ¯ = −.124, k = 198). More importantly, we test several trait-based mechanisms to help explain this relation. Specifically, based on the neo-socioanalytical model of personality change, we hypothesized that those Big Five personality traits that change with age, HEXACO honesty–humility, and trait negative affect mediate this relation. These hypotheses were supported, as the Big Five traits conscientiousness, agreeableness, and neuroticism, as well as honesty–humility and trait negative affect simultaneously mediated the negative relation between age and workplace deviance. These findings highlight important underlying mechanisms for this relation and suggest several opportunities for organizations to reduce the occurrence of workplace deviance. Further theoretical and practical implications as well as limitations and future research ideas are discussed.
Holistic Admissions Review in Nursing Education: A Concept Analysis Using Rodgers’ Evolutionary Method
Authors: Hackett Janna M. , Ruyak Sharon L.
Published: November 2021

AIM

The aim of this study was to analyze holistic review within the context of collegiate nursing program admissions.

BACKGROUND

Holistic review is the evaluation of individual qualifications for college admission based on a pattern of individualized factors, including standardized scores, personal characteristics, experiences, abilities, and educational/professional “fit.” Medical schools regularly use holistic review, and more nursing schools may adopt holistic review in the future.

METHOD

Rodgers’ evolutionary method of concept analysis was used to examine usage in current praxis.

RESULTS

Findings support a desire to enhance diversity in collegiate, health-related programs while increasing numbers of culturally competent, qualified providers representative of the US population.

CONCLUSION

Holistic review promotes diversity of nursing students and future nurse providers. This concept analysis provides a unified definition of holistic review to promote educational and health-care-related equity through increased representativeness of nursing students and future nurses.
Nanoliposomal irinotecan with 5-fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy: A real-world experience
Authors: Yu Hung-Yuan , Lee Chun-Yang , Lin Le-Gin , Chao Yee , Li Chung-Pin
Published: November 2021

Background:

Nanoliposomal irinotecan (nal-IRI), accompanied by 5-fluorouracil (5-FU) and leucovorin (LV), is an effective and safe therapy for patients in whom metastatic pancreatic ductal adenocarcinoma has progressed after gemcitabine-based chemotherapy. Our aim was to evaluate the effectiveness and safety of a nal-IRI + 5-FU/LV regimen for patients with metastatic pancreatic cancer and gemcitabine-based treatment failure in the real world.

Methods:

We retrospectively collected the baseline characteristics, treatment courses and dosage, treatment response, overall survival (OS), progression-free survival (PFS), and adverse effects of patients treated with the nal-IRI-based regimen at Taipei Veterans General Hospital.

Results:

Sixty-seven patients who received the nal-IRI + 5-FU/LV regimen from August 2018 to June 2019 were identified. Their median age was 65 years and 52% were male. Most patients had an Eastern Cooperative Oncology Group performance status of 0 to 1, but patients with an Eastern Cooperative Oncology Group performance status of 2 to 4 before initiation of the nal-IRI regimen were also enrolled (31%). The median dose intensity was 40.4 mg/m2 and the median treatment duration was 8.3 weeks (range: 5 days–75.7 weeks). Objective response and disease control rates were 10.4% and 38.8%, respectively. The median OS)was 7.9 months (95% confidence interval [CI]: 5.6–10.1 months) and the median PFS was 2.9 months (95% CI: 1.6–4.1 months). Elevated total bilirubin (hazard ratio [HR]: 4.31, 95% CI: 1.21–15.30, p = 0.024), carcinomatosis (HR: 3.75, 95% CI: 1.46–9.66, p = 0.006), and previous treatment with irinotecan (HR: 4.86, 95% CI: 1.67–14.10, p = 0.004) were associated with a worse OS. Previous treatment with irinotecan (HR: 3.03, 95% CI: 1.22–7.49, p = 0.02) was associated with a worse PFS. The most common all-grade adverse effects were anemia (73.9%), nausea (66.2%), and fatigue (61.5%). The most common grade 3–4 adverse effects were neutropenia (21.5%), anemia (18.5%), and diarrhea (15.4%).

Conclusion:

Clinically, nal-IRI + 5-FU/LV is effective and tolerable at reduced doses in patients with metastatic pancreatic adenocarcinoma that has progressed after gemcitabine-based therapy