bluuebunny/crossref_metadata_2025 huggingface dataset:
7 IMPACT OF DAY-TO-DAY BLOOD PRESSURE VARIABILITY TO IN-HOSPITAL MORTALITY IN PATIENTS WITH COVID-19 AND EFFICACY OF ANTIHYPERTENSIVE AGENTS
Authors: Jagannatha G.N.P. , Pradnyana I.W.A.S. , Kamardi S. , Yasmin A.A.A.D.A.
Published: May 2022

Background: Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage, but the impact of BPV to outcome in COVID-19 patients remain unclear.

Objectives: To investigate the relationship between BPV and in-hospital mortality, hypertensive status, severity of COVID-19, and antihypertensives in patients with COVID-19.

Methods: This was a cohort prospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups.

Results: The mean age was 53.85±18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR=1.38; 95%CI=1.13-1.70; p=0.003) or severe COVID-19 (PR=1.39; 95%CI=1.09-1.76; p=0.005). High BPV also significantly increased risk of mortality (HR=2.30; 95%CI=1.73-3,86; p=<0.001). Patients with severe COVID-19, hypertension, and high BPV had the highest risk of in-hospital mortality (HR=3.51; 95%CI=2.32-4,97; p<0.001) compared to other groups. In COVID-19 patients with hypertension, CCB had significantly decreased BPV (PR=0.50; 95%CI=0.27-0.93; p=0.004) and mortality (HR=0.17; 95%CI=0.05-0.56; p=0.004).

Conclusions: High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.
9 HYPERURICEMIA AND RISK OF HYPERTENSION RESISTANT TO THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Jayadisastra Z.J. , Kurniawan I.K. , Purnomo N.
Published: May 2022

Background: Hypertension is a common public health problem throughout the world. One of the most common risk factors of hypertension is hyperuricemia. However, there are limited data for the effect of hyperuricemia in hypertension undergoing therapy. The objective of this study is to discover the relationship between hyperuricemia and the risk for resistant hypertension.

Methods: Systematic literature search was conducted based on the PRISMA flow diagram, from PubMed, PubMed Central, Cochrane, and Google Scholar with keywords. “hyperuricemia”, “uncontrolled hypertension”, “resistant hypertension”, and “hypertension”. Data extraction was done and Newcastle-Ottawa Scale was used to assess the study quality. The data was then analyzed using Revman 5.4.1 (Cochrane).

Results: Four selected cohort studies with a total of 8247 patients. All of the included studies have good quality. From the data analysis, we found that hyperuricemia increased the odds of hypertension becoming resistant to therapy (OR: 2.29 [95% CI 1.26, 4.14]; p: 0.006). Forest plot showed the data was evenly distributed.

Conclusion: Hyperuricemia increases the risk of hypertension being resistant to therapy. Therefore, uric acid levels should be controlled in hypertensive patients to optimize the effect of hypertension therapy.
16 OBSERVING PATIENTS' NON-ADHERENCE TO HYPERTENSION CONTROL DURING COVID-19 PANDEMIC: A QUALITATIVE STUDY IN THE PUBLIC HEALTH CENTER SETTING
Authors: Aryadi I Putu Hendri , Pradnyana Made Martha , Ambarini Made Ayu Hapsari Dwi , Kusumawati. I Gusti Ayu Nila
Published: May 2022

Background: COVID-19 pandemic has changed many public' daily practices, including monthly medical check-up among degenerative disease patients, including hypertension patients. Some patients, for many reasons, chose to not check their health status, as well as following their therapy, as usual in the public health center. This qualitative study explored the experience of patients who did not follow their hypertension control during COVID-19 pandemic.

Method: A qualitative study was conducted in Baturiti I Public Health Center around November-December 2021. Eight hypertension patients agreed to participate in one-to-one interview designed to discover their concern regarding anti-hypertensive program non-adherence during COVID-19 pandemic. The interview data was transcribed and analyzed using interpretative phenomenological analysis.

Result: A half of respondents was female, with age range of 45-76 years old. Five out of eight respondents were treated with Amlodipine 10 mg once daily. All of them had been not following their anti-hypertensive therapy for the average of 4.2 months. The fear of being infected with COVID-19 when visiting healthcare facilities was their main reason in skipping monthly hypertension control (62.5%), with no family member to accompany and has already felt well, as the side motive (37.5% and 25.0% respectively). Respondents actually felt guilty to not adhere their anti-hypertensive therapy. They also reported some health complaints, but the worry of being infected by coronavirus turned-off their will to seek for medical help. Their family also worried with their susceptible condition as an elderly. They finally restarted the monthly control when they assumed that the COVID-19 case was relatively decreased.

Conclusion: The fear of being infected by coronavirus was the main reason of patients' non-adherence to their hypertension control during COVID-19 pandemic. A direct run-in-field monthly control could be its one solution.
20 THE CLINICAL SAGA OF RENAL DENERVATION IN UNCONTROLLED HYPERTENSION: AN UPDATED META-ANALYSIS OF RANDOMIZED SHAM-CONTROLLED TRIALS
Authors: Toding Labi Nikita Pratama , Jagannatha Gusti Ngurah Prana , Aji Wingga Chrisna , Pintaningrum Yusra
Published: May 2022

Background: Renal denervation (RDN) with catheter ablation has shown promising yet conflicting results in the management of uncontrolled hypertension. With the availability of recent randomized sham-controlled trials, we decided to perform an updated meta-analysis.

Objective: To examine the utilization of renal denervation in patients with uncontrolled hypertension.

Method: A systematic search in electronic databases was conducted. We included randomized sham-controlled trials comparing RDN and sham procedure in patients with uncontrolled hypertension. Included studies were evaluated for risk of bias. Our outcomes of interest were 24-hour ambulatory blood pressure (BP) and office BP. We performed fixed and random-effects meta-analysis using the inverse variance method to calculate the mean difference (MD) and 95% confidence interval (CI).

Result: Final analysis included 10 studies with a total of 1,571 patients. With the median follow-up period of 6 months, RDN was associated with a significant decrease in 24-hour ambulatory BP (Systolic: MD -3.50 mmHg, 95% CI -4.75, -2.25, p<0.00001, I2=0.00; Diastolic: MD -1.97 mmHg, 95% CI -2.74, -1.20, p<0.00001, I2=0.31) compared to sham procedure. Similiarly, office BP was reduced significantly with RDN when compared to sham procedure (Systolic: MD -4.89 mmHg, 95% CI -7.67, -2.10, p=0.04, I2=0.51; Diastolic: MD -3.07 mmHg, 95% CI -4.14, -2.00, p<0.00001. I2=0.38). Further subgroup analysis showed that radiofrequency RDN was associated with a significant reduction in both 24-hour ambulatory and office BP, while ultrasound RDN was not associated with such differences.

Conclusion: This updated meta-analysis suggests that RDN is associated with statistically significant improvement in uncontrolled hypertension management.
31 ADMISSION OF SYSTOLIC BLOOD PRESSURE AND ANTECEDENT HYPERTENSION WORSENING THE SHORT-TERM OUTCOMES AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Fadlan Muhamad Rizki , Prakosa Ardani Galih , Ivana Diah , Sitio Monica , Pramudya Astrid , Ashari Yordan
Published: May 2022

Background and Aim: The prevalence of antecedent hypertension varies from 46.0% to 63.4%. Until recently, many studies evaluated the prognostic significance of a previous history of hypertension in patients presented with ST-segment elevation myocardial infarction (STEMI) and came to inconsistent result. We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with STEMI.

Materials and Methods: Data were derived from Malang ACS registry of 534 consecutive patients with STEMI. STEMI within 12 hours after the onset of symptoms 2018 and 2020. The diagnosis of STEMI was followed the universal definition of myocardial infarction. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 30-day all-cause mortality.

Results: The prevalence of hypertension was 38.6%, and the best cutoff of admission SBP for predicting 30-day mortality was 94 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often male, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (±94 mmHg) and hypertension group had significantly higher 30-day mortality than those in other groups (all P < 0.000). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 30-day mortality (hazard ratios [HR] 1.66, 95% confidence interval [CI] 1.21—2.16; P < 0.001). In patients with SBP > 94 mmHg, a history of hypertension could increase the risk of 30-day mortality by 17% (HR 1.06 vs 1.37, P = 0.004), while in patients with SBP ± 94 mmHg, this increased risk reached to 44% (HR 1.21 vs 2.38, P < 0.001).

Conclusion: Low admission SBP was the relatively dominant contributor for predicting 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality
33 HYPERTENSION AND PRE-EXISTING COMORBIDITIES ASSOCIATES WITH MAJOR ADVERSE CARDIAC EVENTS IN CORONARY ARTERY DISEASE PATIENTS ADMITTED TO INTENSIVE CARDIOVASCULAR CARE UNIT IN SANGLAH HOSPITAL: THE MANY FACES OF A SILENT KILLER
Authors: Upadhana P.S. , Sastrawan I.G.G. , Putri A.T.D. , Darmayanti N.L.S. , Jagannatha G.N.P. , Umam A.K. , Pradnyana I.W.A.S. , Cahyarini I.G.A.A.C , Wijaya A.R. , Wibhuti I.B.R.
Published: May 2022

Background: Coronary artery disease (CAD) patients with a history of hypertension and underlying comorbidities are at high risk of developing major adverse cardiac events (MACE) and increase the mortality of the patients.

Objective: This study aims to determine the association of hypertension and MACE in CAD patients admitted to ICCU.

Method: This research is an analytic study with a cross-sectional approach. The data used is secondary data from the records of patients who were admitted to ICCU at Sanglah Hospital on 1 January 2021- 31 December 2021 with total sampling technique.

Result: There were 376 patients included in this study. The majority of patients were male (n=291,77.4%) with the median overall patient age of 58 years old. Most of MACE found in the patients were revascularization (n=113;30.1%). The prevalence of hypertension was 19.1%. There were significant differences in length of in hemoglobin (p=0.006), lymphocytes count (p=0.002), uric acid (p=0.032) and GFR (p=0.000) in the patients classified based on MACE. MACE was significantly associated with hypertension (PR=1.285;95%CI=1.102-1.498;p=0.006). Chi-square analysis showed that stroke (PR=2.386;95%CI=1.271-4.480;p=0.007), heart failure (PR=2.533;95%CI=1.574-4.078;p=0.000), and malignant arrhythmia (PR=1.820;95%CI=1.229-2.694;p=0.004) were significantly associated with hypertension. Association of hypertension and kidney disease were significantly associated with stroke (PR= 2.386;95%CI=1.271-4.480;p=0.007), malignant arrhythmia (PR=1.820;95%CI=1.229-2.694;p=0.004) and heart failure (PR=2.533;95%CI=1.574-4.078;p=0.000). Association of hypertension and COVID-19 were also significantly associated with malignant arrhythmia (PR= 2.253;95%CI=1.309-3.877;p=0.011).

Conclusion: There were significant association between hypertension with MACE in the patients. Intervention on these factors can prevent further mortality.
34 CORRELATION BETWEEN URIC ACID LEVEL AND ERECTILE DYSFUNCTION IN CONTROLLED HYPERTENSION MALE PATIENTS
Authors: Sengkey R. , Sugeng C. , Umboh O. , Palar S. , Moeis E.S
Published: May 2022

Background: Uric acid (UA) is considered as a marker of atherosclerosis related to endothelial dysfunction, microvascular disease, and hypertension which plays a major role in erectile dysfunction (ED)

Objective: The aim of this study was to investigate whether there is correlation between UA and ED in controlled hypertension male patients

Methods: This is an observational analytic study with cross sectional approach which has done in Kandou Hospital from October to December 2021. Data analysis was using SPSS 22. This study has been done in 40 to 60-year-old-males, married, alive wife, sexually active at least three months, controlled hypertension. Uric acid was measured by blood serum. Erectile dysfunction was scoring by the International Index of Erectile Function (IIEF-5) questionnaire. The exclusion criteria are acute illness, chronic kidney disease, diabetes mellitus, dyslipidemia, stroke, cancer, obesity, smoking, alcoholic, autoimmune disease, underwent urologic surgery, not taking UA-lowering-therapy in 3 months, having communication problem. Data analysis was using p<0.05

Result: There are 30 males. The age mean was 53.43 ± 7.45 years old. Uric-acid level mean was 6.84 ± 1.56 g/dl. There were 11 patients has mild-moderate ED with 7.85 ± 1.73 g/dl mean-UA level, 12 patients have mild ED with 6.58 ± 1.11 g/dl mean-UA level, and 7 patients has no ED with 5.67 ± 0.99 g/dl mean UA-level. Uric-acid level has significant negative correlation with IIEF-5 score in controlled hypertension male (r = -0.506, p = 0.004)

Conclusion: There is significant correlation between UA level and IIEF-5 score in controlled hypertension male patients
38 THE ROLE OF PEAK ATRIAL LONGITUDINAL STRAIN IN HYPERTENSION HEART DISEASE AS AN INDICATOR FOR EARLY DIASTOLIC LEFT VENTRICLE IMPAIRMENT
Authors: Phalguna S. , Yanni Nani M.
Published: May 2022

Background: Patient with Hypertension Heart Disease (HHD) increase LV feeling pressure and cause remodelling of LV and LA structure. That mechanism leads high pressure in LA. LA strain can be used to gain insight into LA reservoir, conduit, and pump functions. PALS is reflection of LA reservoir function. Often reduced in patient with increased LV filling pressure. LA systolic strain is very accurate marker for estimating raised pulmonary capillary wedge pressure (PCWP). PCWP (E/e') is one of the indicator for diastolic LV disfunction.

Objective: Comparison PALS in patient with controlled HHD and Non-HHD as an indicator for early diastolic LV Impairment.

Methods: 60 patients with normal EF (50% controlled HHD and 50% Non-HHD) were measured PALS used speckle tracking 2D echocardiography. Data were collected from mean of peak LA Strain. Distribution data of PALS was examined with Shapiro-wilk test. Mean PALS between patient with Controlled HHD and Non-HHD were compared, examined used t-pair test.

Result: Total sample 56,7% male and 43,3% female. Mean of hypertension 9 years, age 58 vs 54 (HHD vs Non-HHD), E/e' 8,34 vs 6,06 (HHD vs Non-HHD), LAVI 24,04 vs 18,03 (HHD vs NonHHD). Comparison between PALS in HHD and Non-HHD have significant result (25,05% vs 46,36%, p=0,001).

Conclusion: Patient with HHD decrease mean of PALS. Decrease of PALS is indicated with increased of LV filling pressure. Patient with low PALS can be an indicator for early diastolic LV impairment leading to HFpEF.
41 THE IMPACT OF HYPERTENSION MANAGEMENT EDUCATIONS TOWARDS BLOOD PRESSURE IN UNCONTROLLED HYPERTENSION PATIENTS: QUASI-EXPERIMENTAL STUDY IN FEER RURAL, SOUTHEAST MOLUCCAS
Authors: Gilbert Jeffly Varro , Rugebert Krisyel , Poceratu Kriselda J. , Dewi Norma M.
Published: May 2022

Background: Hypertension is a chronic medical condition in which the blood pressure of the arteries is elevated. It is diagnosed when there is persistent rise (Measured on two occasions) of ≥140 mmHg in systolic blood pressure (SBP) and/or ≥90 mmHg in diastolic blood pressure (DBP) among individual without diabetes, and ≥130 mmHg SBP and/or ≥80 mmHg DBP among individuals with diabetes.

Objective: To Know The Impact of Hypertension Educations Towards Blood Pressure in Uncontrolled Hypertension patients.

Methods: This was a Quasi-experimental study involving all Hypertension patients (n=80) within Feer public health centers, South West Kei Besar District in August 2021. We conducted7 interventions in the form of counseling for hypertension management education on the first day and evaluated every two-weeks for five-months. Data collection was performed by checking blood pressure at pre-intervention and post-intervention. The mean differences between pre-intervention and post-intervention values were analyzed by paired t-tests. All statistical analyses in this study assumed a confidence value of 95 percent.

Results: A paired-samples t-test was conducted to compare pre-intervention and post-intervention values for blood pressure of Uncontrolled Hypertension patients in Hypertension Management Educations. There was a significant difference in Systolic Blood Pressure (Mean=189.08, SD=5.93 vs Mean=119.0, SD=11.42; MD=70.07) and Diastolic Blood Pressure (Mean=106.00, SD=10.47 vs Mean=64.25, SD=3.51; MD=41.75), with p-value <0.05.

Discussion: Interventions in the form of Hypertension management education in Uncontrolled Hypertension Patients can decrease their blood pressure.
Role of Fibular Allograft in Proximal Humerus Fractures: A Systematic Review
Authors: Segarra Borja , Molina Marta , Aguilella Luis
Published: May 2022

Objectives:

To analyze the outcomes and complication rates of fibular allografts (FA) as an augmentation technique for proximal humeral fractures and determine their appropriate indications.

Data Sources:

English- and Spanish-language articles in PubMed, MEDLINE, Embase, Web of Science (Core Collection), and Google Scholar databases were systematically reviewed with the Preferred Reporting Items for Systematic Reviews guidelines on April 10, 2020.

Study Selection:

Studies of patients with proximal humeral fractures treated primarily with FA and locking compression plates and with a minimum follow-up of 6 months were included, and presenting results with standardized clinical scales, radiological values, and operative complications.

Data Extraction:

Two authors independently extracted data from the selected studies with a standardized data collection form. Subsequently, each extracted data set was consolidated on the agreement of authors.

Data Synthesis:

From the initial screening of 361 articles, 5 case series and 6 retrospective cohort studies were included. A meta-analysis was not performed.

Conclusions:

FA improved the clinical and radiological results, thereby reducing complications. The optimal indication for this procedure may be a 4-part fracture with medial column disruption in younger adults.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Statin use is associated with improved overall survival in patients with melanoma
Authors: Madison Cecelia J. , Heinrich Michael C. , Thompson Reid F. , Yu Wesley Y.
Published: May 2022

Melanoma remains a leading cause of cancer morbidity and mortality. Recent literature suggests that statin use may improve outcomes in patients with cancer. In order to determine whether statins may improve survival in melanoma patients, we analyzed data from the Veterans Health Administration Corporate Data Warehouse that contains individually identifiable clinical and demographic information from the 1990s to the present for over 19 million individual veterans. We found that melanoma patients who were taking a statin had better 5-year OS when compared with veterans not taking statins. This relationship remained significant in a multivariate model (hazard ratio, 0.38; 95% confidence interval, 0.34–0.43 for statin user vs. nonuser). Importantly, this effect was much larger than the effect of statins in the general population and was remained after controlling for the use of other medications (beta-blocker), implying that statins may have a direct effect on survival in melanoma patients.
Noncontrast-enhanced 3-Tesla MRI using surface coil as a complementary test for assessment of distribution and depth of locoregional cutaneous metastases of malignant melanoma
Authors: Seyed Jafari Seyed Morteza , Mazinani Mona , Beutler-Minth Verena , Lamos Cristina , Heverhagen Johannes T. , Hunger Robert E. , Daneshvar Keivan
Published: May 2022

Locoregional and distant metastases account for most cases of morbidity and mortality associated with melanoma. In addition, local recurrences of melanoma might be the onset of disseminated disease. Therefore, precise diagnosis and therapy are warranted to minimize morbidity and increase survival in a subset of patients. However, the correct distribution of the metastatic lesions on the skin is often difficult to estimate. We present the application of noncontrast-enhanced 3-Tesla MRI using surface coil to detect locoregional cutaneous metastases of malignant melanoma on the basis of the topographic assessment of skin lesions. Furthermore, in a systematic review, we summarize the current knowledge about application of MRI in assessment of location, distribution, and depth of cutaneous primary malignant melanoma. MRI might be applied to evaluate the location, distribution, size, and depth of the locoregional cutaneous metastasis of malignant melanoma to identify the optimal cost-effective treatment strategies and monitor their effects.
Nearest-Neighbors Matching for Case–Control Study Analyses: Better Risk Factor Identification From a Study of Sporadic Campylobacteriosis in the United States
Authors: Cui Zhaohui , Marder Ellyn P. , Click Eleanor S. , Hoekstra Robert M. , Bruce Beau B.
Published: May 2022

Background:

Case–control studies are commonly used to explore factors associated with enteric bacterial diseases. Control of confounding is challenging due to a large number of exposures of interest and the low frequencies of many of them.

Methods:

We evaluated nearest-neighbors matching in a case–control study (originally 1:1 matched, published in 2004) of sporadic Campylobacter infections that included information on 433 exposures in 2632 subjects during 1998–1999. We performed multiple imputations of missing data (m = 100) and calculated Gower distances between cases and controls using all possible confounders for each exposure in each dataset. We matched each case with ≤20 controls within a data-determined distance. We calculated odds ratios and population attributable fractions (PAFs).

Results:

Examination of pairwise correlation between exposures found very strong associations for 1046 pairs of exposures. More than 100 exposures were associated with campylobacteriosis, including nearly all risk factors identified using the previously published approach that included only 16 exposures and some less studied, rare exposures such as consumption of chicken liver and raw clams. Consumption of chicken and nonpoultry meat had the highest PAFs (62% and 59%, respectively).

Conclusions:

Nearest-neighbors matching appear to provide an improved ability to examine rare exposures and better control for numerous highly associated confounders.
Latent Class Models of Early-life Trauma and Incident Breast Cancer
Authors: Woo Jennifer M. P. , Simanek Amanda , O’Brien Katie M. , Parks Christine , Gaston Symielle , Auer Paul L. , Konkel Rebecca Headley , Jackson Chandra L. , Meier Helen C. S. , Sandler Dale P.
Published: May 2022

Background:

Psychosocial trauma has been hypothesized to influence breast cancer risk, but little is known about how co-occurring traumas—particularly during early life—may impact incidence. We examine the relationship between multiple measures of early-life trauma and incident breast cancer.

Methods:

The Sister Study is a prospective cohort study of US women (n = 50,884; enrollment 2003–2009; ages 35–74). Of 45,961 eligible participants, 3,070 developed invasive breast cancer or ductal carcinoma in situ through 2017. We assessed trauma before age 18 using previously studied measures (cumulative score, individual trauma type, and substantive domain) and a six-class latent variable to evaluate co-occurring traumas. We accounted for missing data using multiple imputation and estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazards models.

Results:

Approximately 49% of participants reported early-life trauma. Using the latent class variable approach, breast cancer hazard was higher among participants who had sexual trauma or household dysfunction (HR = 1.1; CI = 0.93, 1.3) or moderate (HR = 1.2; CI = 0.99, 1.4) but not high trauma (HR = 0.66; CI = 0.44, 0.99) compared to low trauma. Breast cancer HRs associated with sexual early-life trauma or household dysfunction were elevated for pre- and postmenopausal breast cancer and by estrogen receptor status. We found no effect modification by race-ethnicity. Estimated effects were attenuated with report of constant childhood social support.

Conclusions:

Breast cancer incidence varied by latent patterns of co-occurring early-life trauma. Models capturing childhood social support and trauma patterning, rather than cumulative or discrete indicators, may be more meaningful in breast cancer risk assessment.
Clinical Characteristics and Severity Distribution of Tertiary Eye Center Attendance by Ocular Chemical Injury Patients
Authors: Akgun Zeynep , Palamar Melis , Egrilmez Sait , Yagci Ayse , Selver Ozlem Barut
Published: May 2022

Objectives:

To report demographic characteristics, types and grades of injury, regional distribution of injury severity, clinical findings, and long-term results of acute ocular chemical burns.

Methods:

Medical records of patients with chemical burns between 2010 and 2020 who were admitted to Ege University less than 72 hr after the injury were reviewed. Age, gender, cause of the burn, injury severity, initial and final best-corrected visual acuity, surgical intervention, and complications were recorded. The injury severity was graded according to Dua classification.

Results:

A total of 104 patients (137 eyes) were included. The mean age was 42.69±17.39 (7–90) years with a male-to-female ratio of 86:18. The most common causes were home (32.6%) and industrial accidents (45.1%). The causative agent percentages for alkaline, acid, and neutral were 49.0%, 35.5%, and 5.7%, respectively. The percentages of eyes in each grade (1–6) were 16.0%, 16.0%, 15.3%, 16.7%, 17.5%, and 18.2%, respectively. Complications mostly occurred in eyes with grade 2 or higher injuries (83.7%). The relationship between injury grade and limbal stem-cell deficiency was statistically significant (P<0.001). Surgery was mostly needed in grade 4 or higher injuries (44 eyes).

Conclusion:

The severity of the burn is one of the most important prognostic factors in chemical burns. It is important to determine the spreading of the regional injury severity beside the global one to predict complication risk of the injuries. In the present study, the injury distribution was homogeneous in all grades. Limbal stem-cell deficiency development took place mostly in grade 5 and 6 burns as expected.
Ambroxol for neuropathic pain: hiding in plain sight?
Authors: Russo Marc A. , Baron Ralf , Dickenson Anthony H. , Kern Kai-Uwe , Santarelli Danielle M.
Published: May 2022

Ambroxol is a multifaceted drug with primarily mucoactive and secretolytic actions, along with anti-inflammatory, antioxidant, and local anaesthetic properties. It has a long history of use in the treatment of respiratory tract diseases and has shown to be efficacious in relieving sore throat. In more recent years, ambroxol has gained interest for its potential usefulness in treating neuropathic pain. Research into this area has been slow, despite clear preclinical evidence to support its primary analgesic mechanism of action—blockade of voltage-gated sodium (Nav) channels in sensory neurons. Ambroxol is a commercially available inhibitor of Nav1.8, a crucial player in the pathophysiology of neuropathic pain, and Nav1.7, a particularly exciting target for the treatment of chronic pain. In this review, we discuss the analgesic mechanisms of action of ambroxol, as well as proposed synergistic properties, followed by the preclinical and clinical results of its use in the treatment of persistent pain and neuropathic pain symptoms, including trigeminal neuralgia, fibromyalgia, and complex regional pain syndrome. With its well-established safety profile, extensive preclinical and clinical drug data, and early evidence of clinical effectiveness, ambroxol is an old drug worthy of further investigation for repurposing. As a patent-expired drug, a push is needed to progress the drug to clinical trials for neuropathic pain. We encourage the pharmaceutical industry to look at patented drug formulations and take an active role in bringing an optimized version for neuropathic pain to market.
Monthly injectable cabotegravir/rilpivirine to manage HIV infection in adults
Authors: Blackwell Christopher W. , López Castillo Humberto
Published: May 2022

The FDA recently approved a unique treatment regimen for management of HIV-1 infection in adults. A one-time per month injection of cabotegravir/rilpivirine can replace a current, stable antiretroviral regimen in those with virologic suppression, without history of treatment failure, or known or suspected resistance with cabotegravir or rilpivirine. A one-month oral trial should be initiated before switching to the extended-release injectable formulation. Cabotegravir/rilpivirine showed continued virologic suppression without clinically relevant changes in CD4+ cell counts. Clinicians should understand this new HIV regimen, its indications and suitability for select patients, administration and dosing, interactions, and most reported adverse events.
Improving acute pain management of trauma patients on medication-assisted therapy
Authors: Broughton-Miller Kimberly D. , Urquhart Grace Ellen
Published: May 2022

Background:

Approximately 9,500,000 people in the United States misused opioids in 2020. Many people manage their opioid use disorder (OUD) with medication-assisted treatment (MAT). Using MAT to address OUD adds to the complexities and challenges of adequate acute pain control.

Local Problem:

Chart review indicated only 20% of trauma patients on MAT achieved adequate pain control on the trauma service at the University of Louisville Hospital. This quality initiative aimed to increase patient pain control to 50% in 90 days.

Methods:

A rapid cycle quality improvement project with four plan-do-study-act (PDSA) cycles was conducted over 8 weeks. Four core interventions were implemented concurrently, with tests of change biweekly. Qualitative and qualitative data analyses were completed at each cycle.

Interventions:

The core interventions included a risk assessment tool, shared decision-making (SDM) tool, provider checklist, and a team engagement plan.

Results:

The number of patients with a pain score of ≤5 (scale 0–10) increased to 78% from 20%. The mean pain score decreased from 8 to 4.6. The fourth PDSA cycle results showed a 92% patient engagement with SDM and 100% utilization of the provider checklist. Team engagement scores greater than 4 on a 5-point Likert scale were 86%.

Conclusions:

Effective patient-centered acute pain control for trauma patients on MAT is achievable. The combined use of an SDM tool and a provider checklist was an efficient way to provide effective and patient-centered care and positively affected patient outcomes.
Coaching quality improvement in primary care to improve hypertension control
Authors: Saunders Emily , Teall Alice M. , Zurmehly Joyce , Bolen Shari D. , Crane Dushka , Wright Jackson , Perzynski Adam , Lever Jonathan
Published: May 2022

Background:

Effective management of hypertension (HTN) is a priority in primary care, necessary to decrease the costs, morbidity, and mortality associated with cardiovascular disease. Strategies to support quality improvement (QI) efforts in primary care are needed to make significant improvements in population health, especially for patients who experience socioeconomic inequalities.

Local problem:

To address the high rate (>50%) of uncontrolled HTN in the state of Ohio, a statewide QI project was implemented in high-volume Medicaid practices, aimed at improving blood pressure control and addressing racial disparities. The initiative expanded to include coaching QI to support efforts in primary care practices.

Methods:

The Model for Improvement guided development of Plan-Do-Study-Act (PDSA) cycles facilitated by QI coaching and APRN collaboration to implement key components of HTN guidelines: accurate blood pressure measurement, effective treatment, and timely follow-up.

Interventions:

Interventions were implemented after PDSA cycles over 18 months in two practice sites to address HTN control. Linking multiple PDSA test cycles and review of data bimonthly allowed for reflection on the impact of interventions for non-Hispanic Black patients and the overall patient population.

Results:

The percentage of patients with controlled HTN, repeat blood pressure measurement, and timely follow-up improved in an urban primary care practice associated with an academic medical center and in a rural federally qualified health center.

Conclusions:

Primary care practices can benefit from the external support of coaching when implementing QI processes to make meaningful change. APRNs are key collaborators for expanding QI efforts in primary care.
Utilizing Near-Infrared Spectroscopy to Identify Pediatric Trauma Patients Needing Lifesaving Interventions
Authors: Ashby David W. , Balakrishnan Binod , Gourlay David M. , Meyer Michael T. , Nimmer Mark , Drendel Amy L.
Published: May 2022

Objectives

The aim of this study was to prospectively investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs).

Methods

Prospective cohort study of children age 0 to 18 years who activated the trauma team response between August 15, 2017, and February 12, 2019, at a large, urban pediatric emergency department (ED).

The relationship between the lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) was investigated. Categorical variables were analyzed by χ2 test, and continuous variables were analyzed by Student t test.

Results

A total of 148 pediatric trauma patients had somatic NIRS monitoring and met the inclusion criteria. Overall, 65.5% were male with a mean ± SD age of 10.9 ± 6.0 years. Injuries included 67.6% blunt trauma and 28.4% penetrating trauma with mortality of 3.4% (n = 5). Overall, the median lowest somatic NIRS value was 72% (interquartile range, 58%–88%; range, 15%–95%), and 43.9% of patients had a somatic NIRS value <70%. The median somatic NIRS duration recorded was 11 minutes (interquartile range, 7–17 minutes; range, 1–105 minutes). Overall, 36.5% of patients required a LSI including 53 who required a lifesaving procedure, 17 required blood products, and 17 required vasopressors. Among procedures, requiring a thoracostomy was significant.

Pediatric trauma patients with a somatic NIRS value <70% had a significantly increased odds of requiring a LSI (odds ratio, 2.11; 95% confidence interval, 1.07–4.20). Somatic NIRS values <70% had a sensitivity and specificity of 56% and 63%, respectively.

Conclusions

Pediatric trauma patients with somatic NIRS values <70% within 30 minutes of ED arrival have an increased odds of requiring LSIs. Among LSIs, pediatric trauma patients requiring thoracostomy was significant. The role of NIRS in incrementally improving the identification of critically injured children in the ED and prehospital setting should be evaluated in larger prospective multicenter studies.
Perioperative Pain Management in Cleft Lip and Palate Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
Authors: Pfaff Miles J. , Nolan Ian T. , Musavi Leila , Bertrand Anthony A. , Alford Jake , Krishna Vikram , Arowojolu Omotayo A. , Zhu Xiao , Lee Justine C.
Published: May 2022

Background:

Developing effective strategies to manage perioperative pain remains a focus of cleft care. The present study’s purpose was to systematically review perioperative pain control strategies for cleft lip and palate repair.

Methods:

A systematic review and meta-analysis of randomized controlled trials was performed. Primary outcomes included pain scale scores and time to analgesia failure. Cohen d normalized effect size permitted comparison between studies, and a fixed-effects model was used for analysis. I
2 and Q-statistic p values were calculated.

Results:

Twenty-three studies were included: eight of 23 studies provided data for meta-analytic comparison. Meta-analyses evaluated the efficacy of intraoperative nerve blocks on postoperative pain management. Meta-analysis included a total of 475 treatment and control patients. Cleft lip studies demonstrated significantly improved pain control with a nerve block versus placebo by means of pain scale scores (p < 0.001) and time to analgesia failure (p < 0.001). Measurement of effect size over time demonstrated statistically significant pain relief with local anesthetic. Palatoplasty studies showed significantly improved time to analgesia failure (p < 0.005) with maxillary and palatal nerve blocks. Multiple studies demonstrated an opioid-sparing effect with the use of local anesthetics and other nonopioid medications. Techniques for nerve blocks in cleft lip and palate surgery are reviewed.

Conclusions:

The present systematic review and meta-analysis of randomized controlled studies demonstrates that intraoperative nerve blocks for cleft lip and palate surgery provide effective pain control. Opioid-sparing effects were appreciated in multiple studies. Intraoperative nerve blocks should be considered in all cases of cleft lip and palate repair to improve postoperative pain management.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Intimate partner violence and oral HIV pre-exposure prophylaxis adherence among young African women
Authors: Giovenco Danielle , Pettifor Audrey , Powers Kimberly A. , Hightow-Weidman Lisa , Pence Brian W. , Celum Connie , Delany-Moretlwe Sinead , Hosek Sybil , Donnell Deborah , Anderson Peter L. , Mgodi Nyaradzo , Bekker Linda-Gail
Published: May 2022

Objective:

To estimate the effect of intimate partner violence (IPV) on oral pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW).

Design:

We conducted a secondary analysis of data from HIV Prevention Trials Network 082 (HPTN 082), a multisite prospective study designed to assess oral PrEP adherence among AGYW in southern Africa.

Methods:

We estimated the relative prevalence of high PrEP adherence 3 and 6 months after initiation among AGYW 16–25 years who reported a history of any IPV in the past year at enrollment versus AGYW who did not, both overall and by age. High adherence was defined as an intracellular tenofovir-diphosphate concentration at least 700 fmol/punch or more dried blood spots.

Results:

Among 409 PrEP-initiating AGYW, half (49%) reported experiencing any IPV by a current/recent partner in the year prior to enrollment. Overall, a similar proportion of AGYW who reported IPV had high PrEP adherence at months 3 and 6 as AGYW who did not report IPV. There was, however, evidence of effect modification by age at month 3: among AGYW less than 21 years old, those who reported IPV were less than half as likely to have high adherence [adjusted PR (aPR) = 0.43, 95% confidence interval (CI) 0.22–0.86]; among AGYW aged 21 years or older, those who reported IPV were more than twice as likely to have high adherence (aPR = 2.21, 95% CI 1.34–3.66). At month 6, effect estimates within each age stratum were consistent in direction to those at month 3.

Conclusion:

IPV events may either impede or motivate PrEP adherence among African AGYW, with age appearing to be an important consideration for IPV-related adherence interventions.
Increased signal complexity is associated with increased mating success
Authors: Choi Noori , Adams Matt , Fowler-Finn Kasey , Knowlton Elise , Rosenthal Malcolm , Rundus Aaron , Santer Roger D. , Wilgers Dustin , Hebets Eileen A.
Published: May 2022

The evolution of complex signals has often been explored by testing multiple functional hypotheses regarding how independent signal components provide selective benefits to offset the costs of their production. In the present study, we take a different approach by exploring the function of complexity
per se
. We test the hypothesis that increased vibratory signal complexity—based on both proportional and temporal patterning—provides selective benefits to courting male
Schizocosa stridulans
wolf spiders. In support of this hypothesis, all of our quantified metrics of vibratory signal complexity predicted the mating success of male
S. stridulans.
The rate of visual signalling, which is mechanistically tied to vibratory signal production, was also associated with mating success. We additionally found evidence that males can dynamically adjust the complexity of their vibratory signalling. Together, our results suggest that complexity
per se
may be a target of female choice.
Metabolic control of epigenetic rearrangements in B cell pathophysiology
Authors: Calciolari Beatrice , Scarpinello Greta , Tubi Laura Quotti , Piazza Francesco , Carrer Alessandro
Published: May 2022

Both epigenetic and metabolic reprogramming guide lymphocyte differentiation and can be linked, in that metabolic inputs can be integrated into the epigenome to inform cell fate decisions. This framework has been thoroughly investigated in several pathophysiological contexts, including haematopoietic cell differentiation. In fact, metabolite availability dictates chromatin architecture and lymphocyte specification, a multi-step process where haematopoietic stem cells become terminally differentiated lymphocytes (effector or memory) to mount the adaptive immune response. B and T cell precursors reprogram their cellular metabolism across developmental stages, not only to meet ever-changing energetic demands but to impose chromatin accessibility and regulate the function of master transcription factors. Metabolic control of the epigenome has been extensively investigated in T lymphocytes, but how this impacts type-B life cycle remains poorly appreciated. This assay will review our current understanding of the connection between cell metabolism and epigenetics at crucial steps of B cell maturation and how its dysregulation contributes to malignant transformation.
Cervicovaginal loads of Gardnerella spp. are increased in immunocompetent women with persistent high-risk human papillomavirus infection
Authors: Belleti Rafael , Marcolino Larissa Doddi , Novak Juliano , Ferreira Carolina Sanitá Tafner , do Nascimento Bolpetti Aline , da Silva Pinto Gabriel Vitor , de Oliveira Ana Palmeira , da Silva Márcia Guimarães , Marconi Camila
Published: May 2022

Introduction. Two high-oncogenic-risk human papilomavirus (hrHPV) genotypes – HPV16 and HPV18 – cause most of the cases of cervical cancer worldwide. Bacterial vaginosis is associated with increased hrHPV persistence, although the mechanism underlying this association remains unclear.

Gardnerella

spp. are detected in nearly all cases of bacterial vaginosis and are the major source of cervicovaginal sialidases. The NanH1 gene is present in virtually all

Gardnerella

sialidase-producing strains and has been proposed as a potential marker for persistent hrHPV infection.

Hypothesis.

Gardnerella

spp. load and the NanH1 gene are associated with hrHPV persistence.

Aim. To compare the cervicovaginal load of

Gardnerella

spp. and the frequency of the NanH1 gene between women with persistent HPV16 and/or HPV18 infection and those who cleared the infection after 11 months.

Methodology. Among a population of 1638 HPV screened, we detected 104 with positive HPV16 and/or HPV18 results. Samples were obtained at two time points (baseline and at a median of 11 months at follow-up) and tested using the Linear Array HPV Genotyping kit (Roche Molecular Systems, Pleasanton, CA, USA). Based on their HPV16/HPV18 status at enrolment and follow-up, participants were assigned to ‘persistence’ or ‘clearance’ groups. We used cervicovaginal fluid samples obtained upon enrolment to determine the load of the 23 s rRNA gene of

Gardnerella

spp. and the presence of the NanH1 gene using real-time polymerase chain reaction (PCR). We compared

Gardnerella

spp. loads and NanH1 frequency between the groups by, respectively, Mann–Whitney and chi-squared tests, with a P-value <0.05 considered to be significant.

Results. Of the 104 participants who were positive for HPV16/HPV18, 73 (70.2 %) persisted with at least 1 of the baseline genotypes at follow-up, while 31 (29.8 %) cleared the infection in this time frame. Participants in the persistence group had significantly higher loads of

Gardnerella

spp. [5.8E+02 (0–3.0E+05) copies µl−1] than those in the clearance group [9.9E+01 (0–7.7E+04) copies µl−1] (P=0.03). The baseline frequency of NanH1 was higher in the persistence’ (n=46, 63.0 %) than in the clearance (n=14, 45.2 %) group, although this was not statistically significant (P=0.09).

Conclusion. These findings reinforce the negative effect of vaginal microbiota for the clearance of hrHPV and indicate a possible association between sialidase-producing species with hrHPV persistence.