bluuebunny/crossref_metadata_2025 huggingface dataset:
Strengths and Challenges of Implementing a Learning Collaborative in the Ryan White HIV/AIDS Program
Authors: Evans Leigh , Carter Jennifer , Costa Michael , Isenberg Deborah , Procopio Luigi S. , Young Steven R.
Published: June 2021

Learning collaboratives (LCs) are a popular tool for supporting collaboration and shared learning among health programs. Many variations of LCs have been reported in the literature. However, descriptions of key LC components and implementation lack standardization, making it hard to compare and contrast different LC approaches. To advance the field’s understanding of how primary elements of LCs are implemented, we describe the implementation of an LC in the Ryan White HIV/AIDS Program using a recently established taxonomy of four primary elements of LCs—innovation, social systems, communication, and time. Additionally, we explain the strengths and challenges we encountered with regard to each of these elements when implementing this LC. We then offer recommendations to others on how to leverage LC facilitators and mitigate challenges in future projects. This information can guide other programs to replicate beneficial practices and avoid pitfalls in future LC projects.
Therapeutic Properties of Honey for the Management of Wounds; Is There a Role in the Armamentarium of Diabetic Foot Ulcer Treatment? Results From In vitro and In vivo Studies
Authors: Anastasiou Ioanna A. , Eleftheriadou Ioanna , Tentolouris Anastasios , Samakidou Georgia , Papanas Nikolaos , Tentolouris Nikolaos
Published: June 2021

Diabetic foot ulcers are one of the most dreadful complications of diabetes mellitus and efforts to accelerate diabetic wound healing are of paramount importance to prevent ulcer infections and subsequent lower-limb amputations. There are several treatment approaches for the management of diabetic foot ulcers and honey seems to be a safe and cost-effective therapeutic approach on top of standard of care. The aim of this review was to summarize the therapeutic properties of honey and the data regarding its possible favorable effects on diabetic wound healing. A literature search of articles from 1986 until April 2021 was performed using MEDLINE, EMBASE, and the Cochrane Library to assess for studies examining the therapeutic wound healing properties of honey, it's in vitro effect, and the efficacy and/or mechanism of action of several types of honey used for the treatment of diabetic animal wounds. Honey has antioxidant, anti-inflammatory, and antibacterial properties and in vitro studies of keratinocytes and fibroblasts, as well as studies in diabetic animal models show that treatment with honey is associated with increased re-epithelialization and collagen production, higher wound contraction, and faster wound healing. The use of honey could be a promising approach for the management of diabetic foot ulcers.
Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage
Authors: Azhar Ahmed , Basheer Magdy , Abdelgawad Mohamed S. , Roshdi Hossam , Kamel Mohamed F.
Published: June 2021

Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD −ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender ( P > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD ( P < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; P < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation ( P < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.
Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report
Authors: Korleski Hee , DiChiacchio Laura , Araujo Luiz , Hall Michael R.
Published: June 2021

Background:

Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning.

Case Presentation:

The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications.

Discussion:

The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.
The Anxiety Depression Pathway Among Men Following a Prostate Cancer Diagnosis: Cross-Sectional Interactions Between Anger Responses and Loneliness
Authors: Rice Simon M. , Kealy David , Ogrodniczuk John S. , Seidler Zac E. , Montaner Gabriela , Chambers Suzanne , Oliffe John L.
Published: June 2021

Anger has been a largely neglected emotion in prostate cancer research and intervention. This paper highlights the role of anger in the anxiety depression pathway among men with prostate cancer, and whether its impact is dependent on loneliness. Data are presented from a sample of men with prostate cancer ( N = 105, M = 69.12 years, prostatectomy = 63.8%) and analysed using conditional process analysis. Dimensions of anger were evaluated as parallel mediators in bi-directional anxiety and depression pathways. Loneliness was evaluated as a conditional moderator of identified significant mediation relationships. Moderate severity depression (16.5%) was endorsed more frequently than moderate severity anxiety (8.6%, p = .008), with 19.1% of the sample reporting past two-week suicide ideation. Consistent with hypotheses, anger-related social interference (but not other dimensions of anger) significantly mediated the anxiety-depression pathway, but not the reverse depression-anxiety pathway. This indirect effect was conditional on men experiencing loneliness. Sensitivity analyses indicated the observed moderated mediation effect occurred for affective, but not somatic symptoms of depression. Findings support anger-related social interference (as opposed to anger frequency, intensity, duration or antagonism) as key to explaining the previously established anxiety-depression pathway. Results underscore the need for enhanced psychosocial supports for men with prostate cancer, with a particular focus on relational aspects. Supporting men with prostate cancer to adaptively process and manage their anger in ways that ameliorate negative social consequences will likely enhance their perceived social support quality, which may in turn better facilitate post-diagnosis recovery and emotional adjustment.
Clinical value of serum and exhaled breath condensate inflammatory factor IL-11 levels in non-small cell lung cancer: Clinical value of IL-11 in non-small cell lung cancer
Authors: Wu Jinnan , Chen Jinliang , Lv Xuedong , Yang Qichang , Yao Sumei , Zhang Dongmei , Chen Jianrong
Published: June 2021

Objective:

Our study aimed to observe and evaluate the clinical value of interleukin (IL)-11 in the serum and exhaled breath condensate of patients with non-small cell lung cancer (NSCLC).

Methods:

A total of 91 patients with NSCLC and 72 healthy volunteers were included in this study. IL-11 concentration was determined by ELISA, and the relationship between IL-11 expression in serum and exhaled breath condensate specimens, and the clinicopathological characteristics of patients with NSCLC were analyzed. The relationship between serum IL-11 expression and traditional tumor markers and inflammation indicators of NSCLC was also analyzed. The correlation between serum IL-11 and exhaled breath condensate IL-11 level was determined. The receiver operating characteristic curve was used to evaluate the diagnostic value of IL-11 and carcinoembryonic antigen single and combined detection for NSCLC. The published data from online databases were used to analyze the relationship between the expression of IL-11 and the prognosis of NSCLC.

Results:

IL-11 concentration in serum and exhaled breath condensate specimens of patients with NSCLC were significantly increased. IL-11 expression was positively correlated with lymph node metastasis, distant metastasis, tumor node metastasis stage, and tumor differentiation degree of NSCLC. The expression of IL-11 in serum was positively correlated with that in exhaled breath condensate specimens. IL-11 expression was closely related to that of neutrophil-to-lymphocyte ratio and carcinoembryonic antigen. The combination of serum IL-11 with exhaled breath condensate IL-11 and carcinoembryonic antigen showed significantly higher diagnostic value than any one marker alone. Besides, the high IL-11 expression was closely related to the poor prognosis of NSCLC.

Conclusion:

IL-11 can be used as a potential diagnostic and prognostic biomarker for NSCLC.
Optimization for medical logistics robot based on model of traveling salesman problems and vehicle routing problems
Authors: Jin Hui , He Qingsong , He Miao , Lu Shiqing , Hu Fangchao , Hao Daxian
Published: June 2021

Fast medicine dispensing system (FMDS) as a kind of medical logistic robot can dispense many drugs for one prescription at the same time. To guarantee the sustainability of drug dispensation, it is required that FMDS replenish drugs rapidly. The traditional order picking model (OPM) is difficult to meet the demand of prompt replenishment. To solve the problems of prolonged refilling route and inefficiency of drugs replenishment, a mixed refilling model based on multiple steps traveling salesman problem model (MTSPM) and vehicle routing problem model (VRPM) is proposed, and it is deployed in two circumstances of FMDS, including temporary replenishment mode (TRM) and concentrate replenishment mode (CRM). It not only meted the demand under different circumstances of drug replenishment but also shortened the refilling route significantly. First, the new pick sets were generated. Then, the orders of pick sets were optimized and the new paths were achieved. When the number of pickings is varied no more than 20, experiment results declared that the refilling route is the shortest by utilizing MTSPM when working under the TRM condition. Comparing MTSPM with OPM, the rate of refilling route length decreased up to 32.18%. Under the CRM condition, the refilling route is the shortest by utilizing VRPM. Comparing VRPM with OPM, the rate of refilling route length decreased up to 58.32%. Comparing VRPM with MTSPM, the rate of refilling route length has dropped more than 43.26%.
IRAK-4 in macrophages contributes to inflammatory osteolysis of wear particles around loosened hip implants
Authors: Zhang Yang-chun , Xiao Jian-hong , Deng Shao-jie , Yi Guo-liang
Published: June 2021

TLRs recognizing PAMPS play a role in local immunity and participate in implant-associated loosening. TLR-mediated signaling is primarily regulated by IL-1 receptor associated kinase-M (IRAK-M) negatively and IRAK-4 positively. Our previous studies have proved that wear particles promote endotoxin tolerance in macrophages by inducing IRAK-M. However, whether IRAK-4 is involved in inflammatory osteolysis of wear particles basically, and the specific mechanism of IRAK-4 around loosened hip implants, is still unclear. IRAK-4 was studied in the interface membranes from patients in vivo and in particle-stimulated macrophages to clarify its role. Also, IL-1β and TNF-α levels were measured after particle and LPS stimulation in macrophages with or without IRAK-4 silenced by siRNA. Our results showed that the interface membranes around aseptic and septic loosened prosthesis expressed more IRAK-4 compared with membranes from osteoarthritic patients. IRAK-4 in macrophages increased upon particle and LPS stimulation. In the former, IL-1β and TNF-α levels were lower compared with those of LPS stimulation, and IRAK-4 siRNA could suppress production of pro-inflammatory cytokines. These findings suggest that besides IRAK-M, IRAK-4 also plays an important role in the local inflammatory reaction and contributes to prosthesis loosening.
Tocilizumab in refractory Caucasian Takayasu’s arteritis: a multicenter study of 54 patients and literature review
Authors: Prieto-Peña Diana , Bernabeu Pilar , Vela Paloma , Narváez Javier , Fernández-López Jesús C. , Freire-González Mercedes , González-Álvarez Beatriz , Solans-Laqué Roser , Callejas Rubio José L. , Ortego Norberto , Fernández-Díaz Carlos , Rubio Esteban , García-Morillo Salvador , Minguez Mauricio , Fernández-Carballido Cristina , de Miguel Eugenio , Melchor Sheila , Salgado Eva , Bravo Beatriz , Romero-Yuste Susana , Salvatierra Juan , Hidalgo Cristina , Manrique Sara , Romero-Gómez Carlos , Moya Patricia , Álvarez-Rivas Noelia , Mendizabal Javier , Ortiz-Sanjuán Francisco , Pérez de Pedro Iván , Alonso-Valdivielso José L. , Perez-Sanchez Laura , Roldán Rosa , Fernandez-Llanio Nagore , Gómez de la Torre Ricardo , Suarez Silvia , Montesa Cabrera María Jesús , Delgado Sánchez Mónica , Loricera Javier , Atienza-Mateo Belén , Castañeda Santos , González-Gay Miguel A. , Blanco Ricardo
Published: June 2021

Objective:

To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu’s arteritis (TAK) in clinical practice.

Methods:

A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed.

Results:

The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5–50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0–31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5–50.0) to 5.0 (0.0–5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0–14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX ( n = 28), cyclosporine A ( n = 2), azathioprine ( n = 1). Patients on TCZCOMBO were younger [38.0 (27.0–46.0) versus 45.0 (38.0–57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0–38.0) versus 6.0 (1.0–23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7–5.6) versus 1.3 (0.3–3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal.

Conclusion:

TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.
Non-steroidal anti-inflammatory drugs in the pharmacological management of osteoarthritis in the very old: prescribe or proscribe?
Authors: Cadet Christian , Maheu Emmanuel ,   and The French AGRHUM Group (Association Geriatric and RHeUMatology)
Published: June 2021

Osteoarthritis (OA) is the most common form of arthritis worldwide, and ranges in the top 5–10 most disabling diseases. Contrary to common opinion, this disease is severe, often symptomatic, and may lead to loss of mobility and independence, as well as being responsible for increased frailty and excess mortality [standardized ratio: 1.55 (95% confidence interval, CI: 1.41–1.70)]. The incidence of OA increases dramatically with age in an increasingly ageing world. Therefore, practitioners involved in the management of OA often have to manage very old patients, aged 75–80 years and above, as part of their daily practice. Treatment options are limited. In addition to education and physical treatments, which are at the forefront of all treatment recommendations but require a low level of symptoms to be implemented, many pharmacological options are proposed. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as a second-line treatment but with great caution. However, the precise incidence of cardiovascular, renal, and gastrointestinal adverse events in very elderly patients is unclear. All of these risks are increased in the elderly. The relative risks can be extrapolated from various studies. However, what is the absolute risk according to age categorization? The answer to this question is important because NSAIDs should be used in very elderly patients with OA only if full information has been provided and the decision to prescribe this treatment is shared between the patient and their doctor. This article reviews the risks and currently available recommendations, and proposes practical options and warnings to allow for a responsible and limited use of NSAIDs in the very old.

Plain language summary

NSAIDS in the very Old : Prescribe or Proscribe? Osteoarthritis (OA) in the very old is a serious disease leading to loss of independence, frailty, and excess mortality. Quantitative data from clinical trials and population-based observational studies on the risk of NSAID-related side effects allow the prescriber to provide more accurate information to each patient. If there is no contraindication, the decision to initiate NSAID therapy in a very old OA patient should be made in a shared manner, with the patient fully informed of the risks.
Experience of Using Telehealth for Foot and Ankle Examination During The SARS-COV-2 Crisis
Authors: Jeong Su Ryeon , Lin Shangzhe George , Hamilton Paul , Sott Andrea , Yousaf Sohail
Published: June 2021

The era of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is rapidly evolving. To comply to the guidelines for social distancing and reducing travel to prevent the spread of disease, many centers made rapid adjustments to conduct follow-up appointments through telehealth mediums. We explore our center’s adaptation to the pandemic, reflecting on how we formulated telehealth clinics for our patients. We share our experience, discuss the challenges encountered, the feedback received, as well as consider the future role of telehealth in everyday orthopaedic practice.

Levels of Evidence: Level V
Steroid-Induced Avascular Necrosis in the Foot and Ankle—Pathophysiology, Surgical, and Nonsurgical Therapies: Case Study and Literature Review
Authors: Chen Shirley , Kavanagh Amber , Zarick Caitlin
Published: June 2021

Steroid-induced avascular necrosis (AVN) of the lower extremity is a destructive process of the bone found in patients who have been treated with these medications for a variety of medical conditions. There are several proposed etiologies for development of this condition, however much debate still remains for the exact pathophysiology. The main clinical characteristics include edema, arthralgias, and restricted joint range of motion. Diagnostic imaging is a key aspect in the analysis of this pathologic process. When steroid-induced AVN affects multiple bones, this atypical presentation is difficult to treat due to its diffuse nature, therefore surgical options are limited. In these cases, conservative therapy is targeted toward pain relief and preserving joint range of motion. This review aims to provide an overview on the presentation of steroid-induced AVN in the foot and ankle, outline the pathophysiology of the process, and describe a variety of both conservative and surgical treatment options. A case study is provided to showcase a patient presentation of diffuse steroid-induced AVN of the foot and ankle and their course of treatment.

Levels of Evidence: Level V: Expert opinion
Pain and Complications Following Bone Marrow Aspirate Concentrate Harvested From the Iliac Crest in Foot and Ankle Surgery
Authors: Elattar Osama , Christophersen Christy M. , Farber Daniel
Published: June 2021

Background

Autologous bone graft is the gold standard in orthopedics, with the iliac crest the most common harvest site. In an attempt to minimize morbidity with open bone graft harvest from the iliac crest and still maintain the benefit of collecting and transplanting live cells and growth factors, bone marrow aspirate concentrate (BMAC) from the iliac crest has become increasingly popular. However, any harvest procedure can potentially cause pain and complications. The purpose of this study was to evaluate the safety and complications of BMAC from the iliac crest for use in foot and ankle fusion procedures.

Methods

A retrospective chart review was performed on all patients who underwent BMAC harvest from the iliac crest with their foot or ankle procedure by 1 of 4 fellowship-trained surgeons (2014-2017) with a minimum of 6-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the harvest. The final outcome follow-up was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31-81 years) and 69% were women.

Results

Out of 55 patients, 52 (94.5%) reported good to excellent results, and satisfaction with the procedure at the time of the questionnaire. Three patients reported persistent complications and some element of dissatisfaction after 6 months. Some patients reported transient complications (hematomas and numbness) that eventually resolved. Fifty percent of patients reported some element of immediate post-operative pain. However, at the time of final follow-up, only 2 reported persistent pain at the harvest site lasting up to 6 months, but it was not activity limiting.

Conclusion

BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity.

Levels of Evidence

Level IV: Case series
Fibular Rod Osteosynthesis in Ankle Fractures With Compromised Soft Tissue
Authors: Stake Ingrid Kvello , Gregersen Martin Greger , Molund Marius , Östman Bengt
Published: June 2021

Background

Complications after plate and screw fixation of ankle fractures are frequently reported in the literature, with a higher rate in patients with advanced age, comorbidities, and poor skin conditions. A reduced complication rate has been reported with intramedullary nailing (IMN) of the fibula; however, the indication has been based on the surgeon’s preferences. We report the results after IMN in patients with compromised soft tissue exclusively.

Methods

A total of 71 patients with 72 distal fibula fractures were included in this retrospective study. Information about medical history, the ankle injury, treatment, and complications were collected from the medical records. Additionally, the preinjury and 6-week follow-up radiographs were evaluated.

Results

Postoperative information was available for a minimum of 4.3 years postoperatively or until death. In all, 10 patients had complications related to the nail and required secondary surgery. These included 6 symptomatic hardware issues, 2 construct failures, 1 deep infection, and 1 combined deep infection and construct failure.

Conclusions

After IMN of the fibula, 14% of the patients required reoperation. Our results support the previous literature suggesting IMN as an acceptable surgical alternative where the risk of complications with plate and screw fixation is considered too high. Compromised soft tissue is one important indication.

Level of Evidence:

Level IV: Case series without control
Introduction: Friedrich Engels and geography
Authors: Royle Camilla
Published: June 2021

Friedrich Engels (1820–1895) was Marx’s closest collaborator. He was influential in promoting Marxism both during Marx’s lifetime and after it. However, he is mentioned less often than Marx in geography. This editorial introduces a special issue of Human Geography on Friedrich Engels and Geography. It gives a brief overview of the key events in his life, discusses some of the geographical themes in Engels’ work – especially his relevance for work in political ecology, urbanism and geopolitics – and outlines the contents of the special issue.
Frequency and risk factors of non-alcoholic fatty liver disease in Helicobacter pylori-infected dyspeptic patients: A cross-sectional study
Authors: Siddiqui Basit , Kamran Muhammad , Tikmani Shiyam Sunder , Azmat Rabeea , Mushtaq Zain , Zafar Saad Bin , Khan Muhammad Tahir , Yakoob Javed , Abbas Zaigham
Published: June 2021

Background:

In dyspeptic patients with Helicobacter pylori contributes to non-alcoholic fatty liver disease. However, little evidence available from Pakistan.

Objective:

The study aims to determine the frequency and risk factors of non-alcoholic fatty liver disease in dyspeptic patients with Helicobacter pylori.

Methods:

This cross-sectional study was conducted between 22 November 2016 and 30 June 2018. Adults of age between 18 and 90 years who attended the out-patient department due to abdominal discomfort, pain, fullness, and bloating who underwent upper gastrointestinal tract endoscopy were enrolled after taking informed consent. Patients with celiac disease, inflammatory bowel disease, taking alcohol, pregnant women and lactating mothers, known cases of hepatitis B and C, and history of recent antibiotic use were excluded. Data on age, gender, smoking, alcohol use, dyslipidemia, hypertension, type 2 diabetes mellitus, and ischemic heart disease were collected. Non-alcoholic fatty liver disease was diagnosed through ultrasonography. Helicobacter pylori infection was detected using a carbon urea breath test.

Results:

A total of 698 patients were screened for eligibility, and 399 (57.2%) had Helicobacter pylori infection and were enrolled in the study after consent. The median age was 50.1 (interquartile range = 14.5) years and 209 (52.4%) were males. Frequency of non-alcoholic fatty liver disease in patients with Helicobacter pylori dyspeptic patients was 153 (38.3%). Factors associated with non-alcoholic fatty liver disease in the presence of Helicobacter pylori were dyslipidemia 7.38 (95% confidence interval = 2.4–22.71), type 2 diabetes mellitus 5.96 (95% confidence interval = 1.86–19.07), hypertension 3.0 (95% confidence interval = 1.21–7.45), and moderate gastritis 2.81 (95% confidence interval = 1.2–6.59).

Conclusion:

The frequency of non-alcoholic fatty liver disease in Helicobacter Pylori dyspeptic patients was 38.3%. Male gender, dyslipidemia, hypertension, ischemic heart disease, and moderate gastritis were associated with non-alcoholic fatty liver disease.
Iodide-induced sialadenitis following percutaneous coronary intervention: A case report
Authors: Curley D , Gent D , Patel S
Published: June 2021

Iodide-induced sialadenitis is a rapid, painless enlargement of salivary glands following administration of iodine-based contrast agents. It has been reported numerous times in the literature; however, the pathogenesis remains unclear. This case report demonstrates how this may present following a coronary angiogram.
The first report of kidney transplantation in a human immunodeficiency virus–positive recipient in Thailand and literature review: Encouragement for developing countries in Southeast Asia
Authors: Udomkarnjananun Suwasin , Naiyarakseree Nuanjanthip , Townamchai Natavudh , Surinrat Ekkapong , Tiankanon Kanitha , Banjongjit Athiphat , Vanichanan Jakapat , Jutivorakool Kamonwan , Putcharoen Opass , Suankratay Chusana , Surintrspanont Jerasit , Iampenkhae Kroonpong , Leelahavanichkul Asada , Wattanatorn Salin , Apisutimaitri Kirada , Burimsittichai Rattanaporn , Ratchanon Supoj , Nonthasoot Bunthoon , Sirichindakul Boonchoo , Praditpornsilpa Kearkiat , Avihingsanon Yingyos
Published: June 2021

Patients with human immunodeficiency virus infection are at risk of chronic kidney disease and end-stage renal disease. Human immunodeficiency virus infection impedes patients’ accessibility to transplantation in Thailand and other developing countries in Southeast Asia, where the burdens of human immunodeficiency virus infection and chronic kidney disease are rapidly increasing. We report the successful kidney transplantation in a human immunodeficiency virus–positive recipient in Thailand and provide brief information about the current knowledge of human immunodeficiency virus medicine and transplantation that are needed for conducting kidney transplantations in such patients. Patient selection and evaluation, the choice of antiretroviral therapy, immunosuppressive regimens, and infectious complications are reviewed and discussed. The aim is to encourage kidney transplantation in end-stage renal disease patients with well-controlled human immunodeficiency virus infection, especially in countries where the prevalence of human immunodeficiency virus infection is high and the accessibility to transplantation is still limited.
Diagnostic digital pathology implementation: Learning from the digital health experience
Authors: Betmouni Samar
Published: June 2021

Digital Pathology (also referred to as Telepathology and Whole Slide Imaging) is the process of producing high resolution digital images from tissue sections on glass slides. These glass slides are normally examined under a microscope by a pathologist as part of the diagnostic process. The emergence of digital pathology now means that digital images are stored on secure servers and can be viewed on computer monitors; enabling pathologists to work remotely and to collaborate with other colleagues when second opinions are needed. The implementation of digital pathology into clinical practice has many potential benefits. Although this has been long recognised, its adoption as a diagnostic tool remains low and pathologists’ projections about its future deployment are cautious. Notable early digital pathology adopters have led the way. The challenge now is to scale-up digital pathology beyond the relatively few large networks and centres of excellence. Many other areas of healthcare have accumulated experience about optimising approaches to digital health/healthcare technology deployment and sustainability. This has been done in a multi-disciplinary context and has applied theoretical/conceptual frameworks. Thus far there has been little use of similar frameworks in the planning of digital pathology deployment in clinical practice. In this essay, I will explore the scope of digital pathology implementation approaches that have been deployed in clinical practice and examine what can be learned from the wider healthcare experience of adopting, scaling-up and sustaining innovative healthcare solutions.
SARS-CoV-2 (COVID-19) and audio-vestibular disorders
Authors: Fancello Virginia , Hatzopoulos Stavros , Corazzi Virginia , Bianchini Chiara , Skarżyńska Magdalena B , Pelucchi Stefano , Skarżyński Piotr Henryk , Ciorba Andrea
Published: June 2021

To describe the audio-vestibular disorders related to the newly SARS-CoV-2 infection, including the possible ototoxicity side-effects related to the use of drugs included in the SARS-CoV-2 treatment protocols. A systematic review was performed according to the PRISMA protocol. The Medline and Embase databases were searched from March 1, 2020 to April 9, 2021. Initially the search yielded 400 manuscripts, which were reduced to 15, upon the application of inclusion criteria. Sensorineural hearing loss (SNHL) is the most frequent audio-vestibular symptom described, occurring alone or in association with tinnitus and vertigo. The etiopathogenesis of the inner ear disorders related to COVID-19 infection is still poorly understood. The number of reports of COVID-19 infections associated to audio-vestibular disorders is increasing; even if the quality of the studies available is often insufficient, audio-vestibular disorders should be considered as possible manifestations to be included among the symptoms of this infection.
A critical COVID-19 patient managed with timely evaluation, early prone positioning ventilation, and a multi-pronged pharmacotherapy
Authors: Peng Mian , Li Rongsong , Cao Weiling , Li Weiqing , Wu Ming , Lyu Yansi , Meng Xi , Ji Kunmei
Published: June 2021

There is not yet a standard drug regimen for the treatment of coronavirus disease 2019 (COVID-19) patients. Here, we summarize our experience and successful treatment plan with a critical COVID-19 patient who required mechanical ventilation (MV). A 56-year-old man presented with a fever, cough, and dyspnea. He had not been to a medium/high risk epidemic area in the past year and had no family history of a disease cluster. COVID-19 was suspected based on clinical symptoms and radiologically detected ground-glass lung changes in the context of a normal white blood cell count (WBCC) and lymphocyte fraction (L%). A diagnosis of COVID-19 was confirmed by nucleic acid testing. Initially, he was started on noninvasive ventilation (NIV). Because his respiratory distress worsened over the following 2 h, he was transitioned to mechanical ventilation (MV), placed in prone positioning 12 h/day, and given a multi-pronged pharmacotherapy regimen that included an antiviral cocktail (lopinavir/ritonavir plus α-interferon), an immunity enhancer (thymosin α1), an anti-coagulant to prevent thrombosis (heparin). He was given an antibiotic to treat an opportunistic nosocomial infection. The patient has recovered well. The regimen applied in this case of timely evaluation, early prone positioning with MV, and a multi-pronged pharmacotherapy may be an effective strategy for patients with critical COVID-19, particularly with respect to preventing life-threatening worsening of the illness.
Effect of human breast milk on innate immune response: Up-regulation of bacterial pattern recognition receptors and innate cytokines in THP-1 monocytic cells
Authors: Hahn Won-Ho , Shin Soon Young , Song Jun Hwan , Kang Nam Mi
Published: June 2021

Human breast milk (HBM) contains many bioactive components that protect infants from various microorganisms. Pattern recognition receptors on phagocytic cells recognize microbial pathogens and promote the innate immune system. This study aimed to evaluate the effect of HBM on the expression of pattern recognition receptors and innate cytokines in the monocytic cell line THP-1 and the phagocytic activity of RAW264.7 macrophages. Expression levels of specific mRNAs in THP-1 cells were quantitated using reverse transcription-polymerase chain reaction. Phagocytic activity was measured by fluorescence microscopy to detect the uptake of fluorescent dye-labeled carboxylate-modified polystyrene latex beads in RAW264.7 macrophages. HBM stimulated the phagocytic activity of RAW264.7 macrophages. HBM increased mRNA expression of pattern recognition receptors, including the cluster of differentiation 14 and toll-like receptor 2 and 4, and various innate cytokines, including tumor necrosis factor α, interleukin-1β, C-X-C motif chemokine 8, and C-C motif chemokine ligand 2, in THP-1 monocytic cells. Furthermore, milk oligosaccharides in HBM, such as lacto- N-fucopentaose I, enhanced the expression of pattern recognition receptors and various innate cytokines. HBM is able to modulate the innate immune response by upregulating the expression of pattern recognition receptors and various innate cytokines in monocytes/macrophages.
Cross-Cultural Adaptation and Psychometric Properties of the Portuguese Coaching Life Skills in Sport Questionnaire
Authors: Ciampolini Vitor , Santos Fernando , Quinaud Ricardo Teixeira , Camiré Martin , Migliano Maurício de Oliveira , do Nascimento Juarez Vieira , Milistetd Michel
Published: June 2021

The Coaching Life Skills in Sport Questionnaire (CLSS-Q) is a 5-factor 36-item scale developed in the English language to assess the extent to which coaches are intentional in their approaches to teaching life skills through sport. To allow for usage of the CLSS-Q in Portuguese-speaking countries, the purpose of this study was to investigate the cross-cultural adaptation and the psychometric properties of the Portuguese version of the CLSS-Q (P-CLSS-Q). In Phase 1, the scale was cross-culturally adapted through consecutive stages of translation and back-translation, expert feedback, committee revision, and pretesting. In Phase 2, 753 youth sport coaches (i.e., 376 Brazilians and 377 Portuguese) completed the questionnaire. After randomly splitting participants into two independent samples, the translated and cross-culturally adapted questionnaire was subjected to an exploratory factor analysis and a confirmatory factor analysis. Other analyses were also applied to verify the instrument’s psychometric properties. The results led to a 5-factor 30-item scale with indications that the P-CLSS-Q has some evidence of validity in measuring the extent to which coaches intentionally teach life skills through sport in Portuguese-speaking countries. Future studies are needed to further investigate the psychometric properties of both the CLSS-Q and the P-CLSS-Q in other sociocultural contexts where coaches have varying levels of exposure to the concept of life skills and its implication for coaching practice.
The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty
Authors: Jain Deeptee , Vigdorchik Jonathan M. , Abotsi Edem , Montes Dennis Vasquez , Delsole Edward M. , Lord Elizabeth , Zuckerman Joseph D. , Protopsaltis Themistocles , Passias Peter G. , Buckland Aaron J.
Published: June 2021

Study Design:

Retrospective cohort study.

Objectives:

The interactions between hip osteoarthritis (OA) and spinal malalignment are poorly understood. The purpose of this study was to assess the influence of total hip arthroplasty (THA) on standing spinopelvic alignment.

Methods:

In this retrospective cohort study, patients undergoing THA for OA with pre-and postoperative full-body radiographs were included. Standing spinopelvic parameters were measured. Contralateral hip was graded on the Kellgren-Lawrence scale. Pre-and postoperative alignment parameters were compared by paired t-test. The severity of preoperative thoracolumbar deformity was measured using TPA. Linear regression was performed to assess the impact of preoperative TPA and changes in spinal alignment. Patients were separated into low and high TPA (<20 or >/=20 deg) and change in parameters were compared between groups by t-test. Similarly, the influence of K-L grade, age, and PI were also tested.

Results:

95 patients were included (mean age 58.6 yrs, BMI 28.7 kg/m2, 48.2% F). Follow-up radiographs were performed at mean 220 days. Overall, the following significant changes were found from pre-to postoperative: SPT (14.2 vs. 16.1, P = 0.021), CL (−8.9 vs. −5.3, P = .001), TS-CL (18.2 vs. 20.5, P = .037) and SVA (42.6 vs. 32.1, P = .004). Preoperative TPA was significantly associated with the change in PI-LL, SVA, and TPA. High TPA patients significantly decreased SVA more than low TPA patients. There was no significant impact of contralateral hip OA, PI, or age on change in alignment parameters.

Conclusion:

Spinopelvic alignment changes after THA, evident by a reduction in SVA. Preoperative spinal sagittal deformity impacts this change. Level of evidence: III.
A Cross-Sectional Study to Determine and Compare the Craniofacial Anthropometric Norms in a Selected Kenyan and Chinese Population
Authors: Sarna Krishan , Sonigra Khushboo J. , Ngeow Wei C.
Published: June 2021

Background: Craniofacial anthropometry provides essential data for diagnosis and treatment planning, with the norms for many races having been investigated. The results reveal that facial morphometry varies greatly because of geographical, ethnic, and racial variations. This study aims to gather the normative anthropometric data and compare the differences in facial morphometry between the Kenyan population and that of the Chinese. Methods: Four vertical measurements (trichion–nasion, nasion–subnasale, subnasale–gnathion, and superaurale–subaurale) and 6 horizontal measurements (zygion–zygion, exocanthion–endocanthion, endocanthion–endocanthion, pupil-pupil, alare–alare, and chelion–chelion) were obtained manually from subjects with no craniofacial abnormality. Results: A total of 180 participants (90 Kenyans and 90 Chinese) were included. Among the Kenyans, males generally had greater dimensions in comparison to the Kenyan females with the exception of the upper third, lower third, and intercanthal, and interpupillary distances. Among the Chinese, there was a significant difference between the 2 genders with the exception of intercanthal distance. All measurements were greater in Chinese males in comparison to the females. Comparison between races shows that Kenyans had greater vertical measurements with exception of the ear length for both genders. The Chinese males had increased facial width and intercanthal distance, while the Chinese females showed increased intercanthal distance compared to Kenyans. Kenyans exhibited hyperleptoprosopic-type face, while Chinese exhibited mesoprosopic-type face, with none of the 2 groups conforming to the neoclassical canons. Conclusion: Kenyans generally have greater craniofacial measurements versus Chinese, except for the facial width and intercanthal distance for males and interorbital distance for females.
An International Review to Characterize the Role, Responsibilities, and Optimal Setting for Health Literacy Mediators
Authors: Spencer Madeline , Kemp Nenagh , Cruickshank Vaughan , Otten Claire , Nash Rosie
Published: June 2021

Health literacy is a critically important determinant of health and is influenced by access to supportive social networks and services. Global investment in education throughout the life course is required to support health literacy development. The aim of this review is to characterize the role, responsibilities, and the optimal setting for the emergent role of a Health Literacy Mediator (HLM). A scoping review of recent literature was conducted. The review revealed a lack of consensus on who should be teaching health literacy, and variability in confidence when teaching health literacy. Professionals reported facing barriers such as a lack of time, a lack of knowledge, and recognized that the health literacy needs of children worldwide are not being met. Further research into the role of HLM is required to determine who is best suited to this role and what their responsibilities will be to ensure consistent health literacy education.
Changes in Census Data Will Affect Our Understanding of Infant Health
Authors: Santos-Lozada Alexis R.
Published: June 2021

Descriptions of the effect of the implementation of a new disclosure avoidance system (DAS), which relies on differential privacy, emphasize the impact of our understanding of contemporary social and health dynamics. However, focusing on overall population may obscure important changes in subpopulation indicators such as age-specific rates resulting from this implementation. The author provides a visualization that compares infant mortality rates calculated using 2009–2011 county-level average death counts and denominators derived from the traditional and proposed DASs. Death counts come from the National Center for Health Statistics and denominators come from the first U.S. Census Bureau demonstration products. These visualizations indicate that infant mortality rates produced using the proposed DAS are different from those produced using the traditional methods, with higher variation observed for nonmetropolitan counties and areas with smaller populations. These findings suggest that the proposed DAS will hinder our ability to understand contemporary health dynamics in the United States.
European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis
Authors: Bonati Leo H , Kakkos Stavros , Berkefeld Joachim , de Borst Gert J , Bulbulia Richard , Halliday Alison , van Herzeele Isabelle , Koncar Igor , McCabe Dominick JH , Lal Avtar , Ricco Jean-Baptiste , Ringleb Peter , Taylor-Rowan Martin , Eckstein Hans-Henning
Published: June 2021

Atherosclerotic stenosis of the internal carotid artery is an important cause of stroke. The aim of this guideline is to analyse the evidence pertaining to medical, surgical and endovascular treatment of patients with carotid stenosis. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The working group identified relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Based on moderate quality evidence, we recommend carotid endarterectomy (CEA) in patients with ≥60–99% asymptomatic carotid stenosis considered to be at increased risk of stroke on best medical treatment (BMT) alone. We also recommend CEA for patients with ≥70–99% symptomatic stenosis, and we suggest CEA for patients with 50–69% symptomatic stenosis. Based on high quality evidence, we recommend CEA should be performed early, ideally within two weeks of the last retinal or cerebral ischaemic event in patients with ≥50–99% symptomatic stenosis. Based on low quality evidence, carotid artery stenting (CAS) may be considered in patients < 70 years old with symptomatic ≥50–99% carotid stenosis. Several randomised trials supporting these recommendations were started decades ago, and BMT, CEA and CAS have evolved since. The results of another large trial comparing outcomes after CAS versus CEA in patients with asymptomatic stenosis are anticipated in the near future. Further trials are needed to reassess the benefits of carotid revascularisation in combination with modern BMT in subgroups of patients with carotid stenosis.