bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Welfare by Matching Households across Time
Authors: Baqaee David R , Burstein Ariel T , Koike-Mori Yasutaka
Published: September 2023

The money metric utility function is an essential tool for calculating welfare-relevant growth and inflation. We show how to recover it from repeated cross-sectional data without making parametric assumptions about preferences. We do this by solving the following recursive problem. Given compensated demand, we construct money metric utility by integration. Given money metric utility, we construct compensated demand by matching households over time whose money metric utility value is the same. We illustrate our method using household consumption survey data from the United Kingdom from 1974 to 2017 and find that real consumption calculated using official aggregate inflation statistics overstates money metric utility in 1974 pounds for the poorest households by around 0.5% a year and understates it by around a third of a percentage point per year for the richest households. We extend our method to allow for missing or mismeasured prices, assuming preferences are separable between goods with well-measured prices and the rest. We discuss how our results change if the prices of some service sectors are mismeasured.
Biologic disease-modifying anti-rheumatic drugs are equally effective in psoriatic arthritis patients with low and high joint counts
Authors: Möller Burkhard , Scholz Godehard A , Amsler Jennifer , Ciurea Adrian , Micheroli Raphael , Nissen Michael J , Papagiannoulis Eleftherios , Blapp Christoph , Scherer Almut , Yawalkar Nikhil
Published: September 2023

Objective

A lack of representation in pivotal trials currently limits guidance for the use of biologic DMARDs (bDMARDs) in PsA patients with a low number of actively inflamed joints. The aim of this study was to compare the effectiveness of a first bDMARD in PsA patients with a low vs high number of affected joints.

Methods

PsA patients with available 66/68 joint count assessments were divided into low joint count (LJC) patients when presenting with <3 tender or <3 swollen joints or high joint count (HJC) patients with ≥3 joints in both categories. We studied drug retention as a joint count independent effectiveness variable in LJC and HJC patients in univariate and multivariable adjusted Cox regression models.

Results

A total of 197 LJC patients differed not only in joint counts, but also had lower enthesitis scores, less often dactylitis, less disability and a better health-related quality of life at first bDMARD initiation than 190 HJC patients. However, LJC patients were less often on conventional synthetic DMARDs (csDMARDs). Despite these differences at baseline, bDMARD retention was not significantly different between LJC and HJC patients in both crude and adjusted analyses [hazard ratio (HR) 1.09 (95% CI 0.76, 1.58), P = 0.52]. Furthermore, bDMARD retention was significantly better [HR 0.63 (95% CI 0.47, 0.85), P < 0.002] when administered with csDMARD co-therapy.

Conclusions

bDMARDs were similarly effective in terms of drug retention in patients with low and high joint counts. In the setting of absent remission and a significant disease burden, bDMARDs should not be withheld from patients because they exhibit only a low joint count.
Establishing the Role of Inflammatory Markers in the Diagnosis and Treatment of Acute Hand Infections in the Pediatric Population
Authors: Schutz John , Lalka Andy , Williams Morgan A. , Sibbel Sarah E. , Sinclair Micah K.
Published: September 2023

Introduction:

Distinguishing the severity of the diagnosis and an appropriate treatment plan in pediatric hand infections can be complex due to the variable amount of information available at the presentation. Inflammatory blood markers, including white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are reported to aid in determining the severity of infection and response to treatment in adult hand infections. The purpose of this study was to identify the relevance of inflammatory marker levels in pediatric patients with hand and wrist infections and to determine their utility in diagnosis and treatment.

Methods:

This multicenter, retrospective, cohort study included patients aged 0 to 18 who received treatment for an acute hand or wrist infection between 2009 and 2020. Data collected included demographics, time to presentation, diagnosis, inflammatory markers, culture results, antibiotic treatment, and surgical treatment. Infections were categorized as deep (osteomyelitis, tenosynovitis, abscess) and superficial (paronychia, felon, cellulitis). Exclusion criteria included: patients above 18 years of age, chronic infection, open fractures, and absence of any documented inflammatory markers. Statistically, t tests were used to compare mean differences in inflammatory markers between patients who did and did not receive pretreatment antibiotics and between patients who had superficial versus deep hand infections.

Results:

A total of 123 patients met the inclusion criteria. Pretreatment with antibiotics before definitive management was not significantly associated with differences in laboratory markers compared with patients not pretreated with antibiotics. Deep hand infections had inflammatory markers similar to superficial infections. Patients with deep hand infections required a bedside or operative procedure 78.9% of the time compared with superficial infections (21.2%) (P<0.001). Patients with an isolated methicillin-resistant Staphylococcus aureus infection had inflammatory marker values that were not significantly different from patients infected with all other microbes.

Conclusions:

Inflammatory markers were not significantly different between patients who received pretreatment with antibiotics and those who did not. While deep infections were often treated with bedside or surgical procedures, the inflammatory marker values were similar to those of superficial infections. The same held true for patients infected with culture-positive, isolated methicillin-resistant Staphylococcus aureus bacteria. Consequently, inflammatory markers may be useful to identify the presence of infection and monitor the response to treatment, they did not aid in determining the specific type of infection or selection of a treatment plan.

Level of Evidence:

Level III—retrospective comparative study.
Post-Acute Myocardial Infarction Heart Failure Core Genes and Relevant Signaling Pathways
Authors: Lin Ling , Zicheng Ling , Shaohua Gu
Published: September 2023

There is increasing concern about heart failure after myocardial infarction and the current clinical treatment measures for ventricular remodeling. Herein, we present the results of differential gene analysis, pathway enrichment analysis, and characteristic gene screening. Our study identifies 4 core genes (KLRC2, SNORD105, SNORD45B, and RNU5A-1) associated with post-acute myocardial infarction (AMI) heart failure. The authors discuss the significance of the identified core genes, their potential implications in immune dysfunction and heart failure, and their relevance to disease regulatory genes. The study concludes by emphasizing the importance of clinical relevance in molecular research and suggests potential therapeutic targets for post-AMI heart failure.
A huge gastric trichobezoar presenting with Rapunzel syndrome: A case report
Authors: Lohiya Makhan Lal , Chandawat Parikshit Singh , Rangi Jay Prakash , Lal Mohan , Kulhari Apeksha
Published: September 2023

Trichobezoars are gastrointestinal concretions of ingested hair. These are uncommon conditions that arise in emotionally disturbed or mentally impaired young women during childhood and adolescence. Rapunzel syndrome is rare gastric trichobezoar that extends beyond the pylorus, leading to an intestinal obstruction. Gastric trichobezoars do not manifest symptoms until they are very large. Here, we report a 16-year-old girl with a 5-year history of trichophagia and trichotillomania who suffered from a huge (30 × 7.5 × 6 cm) gastric trichobezoar extending into the duodenum (Rapunzel syndrome) that was successfully addressed by laparotomy, psychiatric treatment, and follow-up.
Flap Viability Evaluation Using a Tissue Oximetry Camera as an Alternative to Indocyanine Green Fluorescence Imaging
Authors: Takaya Ayako , Tsuge Itaru , Nakano Takashi , Yamanaka Hiroki , Katsube Motoki , Sakamoto Michiharu , Morimoto Naoki
Published: September 2023

Indocyanine green (ICG) fluorescence imaging is useful for assessing flap viability; however, it is associated with a risk of anaphylactic shock, even in patients with no history of drug allergies. SnapshotNIR is a noncontact, camera-type handheld tissue oximeter that can measure the tissue oxygen saturation of the body surface. The device emits red and near infrared light wavelengths and then optimizes the measurement of the differential reflectance from oxygenated and deoxygenated hemoglobin, and StO2 is calculated. A 20 × 15 cm surgical field can be evaluated in less than 3 seconds by holding the camera at a distance of 30 cm. We applied this device at zone II in a deep inferior epigastric perforator (DIEP) flap, and compared the findings with the border of flap perfusion detected by ICG imaging. Left breast reconstruction using a free DIEP flap was performed for a 60-year-old woman. The DIEP flap was vascularized by a perforator vessel coursing to the right abdominis muscle. First, Diagnogreen (5 mg; Daiichi Sankyo Co., Tokyo, Japan) was intravenously injected, and the ICG fluorescence perfusion border detected by PDE-neo (Hamamatsu Photonics, Hamamatsu City, Shizuoka, Japan) was determined. The ICG border was defined by two reconstructive surgeons after fluorescence had spread out for 2 minutes. Next, zones Ⅱ and Ⅳ of the DIEP flap, contralateral to the perforator, were evaluated using photographs obtained by SnapshotNIR. There were significant StO2 value differences between the ICG-negative area and ICG-positive area. This device can be widely applied in the noninvasive evaluation of flap viability.
Hinge Strut: A New Septal Strut for Nasal Tip Projection, Definition, and Stability in Latino Noses
Authors: Pérez Willis Wilder A. , Adrianzen Nuñez Gerardo A. , Mendoza Guerra Cynthia P. , Perez Soto Wilder A.
Published: September 2023

Background:

Obtaining ideal support to maintain the nasal tip has been investigated in several rhinoplasty studies. We aimed to describe a support technique, namely the use of a “hinge strut” (HS) for the nasal tip in Latino noses and to evaluate nasolabial angles at 6-months follow-up.

Methods:

In total, 46 Latino patients who had undergone rhinoplasty using the HS technique between June 2021 and June 2022 were recruited in Lima, Peru. All patients had nasolabial angle measurements taken preoperatively and at 1, 3, and 6 months postoperatively in active and passive positions to evaluate angle changes during this 6-month period.

Results:

We evaluated 38 women and six men aged 18–45 years (mean age, 25.74 years). In the passive position, the mean nasolabial angles were 91.5 degrees preoperatively and 106, 104, and 103 degrees at 1, 3, and 6 months, respectively, postoperatively. In the active position, the mean nasolabial angles were 85.5 degrees preoperatively and 102.6, 99.1, and 98.1 degrees at 1, 3, and 6 months, respectively, postoperatively (P < 0.0001, using Friedman chi-square test).

Conclusions:

The HS technique is safe and reproducible, with nasal tip maintenance and an adequate angle elevation trend observed at 6-months follow-up. Further studies and longer observation times are necessary to determine longer-term outcomes.
Indolent cancer and pattern of progression: Two missing parameters in trial design for hepatology
Authors: Iavarone Massimo , Nault Jean-Charles , Cabibbo Giuseppe , Torres Ferran , Reig Maria
Published: September 2023

The indolent and aggressive behaviors of HCC might have a role in clinical trial (CT) results; however, the indolent HCC is less analyzed compared to others cancer. Indolent profile could be characterized as follows: (1) patients with low risk of progression itself due to the HCC molecular profile and/or due to the interaction between cancer cell their microenvironment; (2) patients who achieve objective response or present spontaneous regression; and (3) patients who develop radiological progression with no consequence on either the liver function or general status, and without trigger a change in the tumor stage. Patients with “indolent HCC” generally never develop cancer-related symptoms neither die for HCC-related causes. Thus, we hypothesize that the imbalance in the proportion of “indolent” versus “aggressive HCC” between arms or the underestimation/overestimation of HCC behavior at baseline in single-arm CT could be associated with CT failure or under-overestimation of trial results. The “indolent progression” may also explain the discrepancy between radiological progression-based end points and survival. Moreover, we discuss the related causes that explain the indolent profile of HCC and propose (1) refining the progression-related end point by the pattern of progression to minimize the limitations of the current end points; (2) considering alternative statistical tools for survival analysis such as milestone survival, or restricted mean survival time to capture the value of indolent HCC. According to these considerations, we propose incorporating novel end points into the single arm of phase I/II CT as exploratory analysis or as a secondary end point in phase III CT.
Early steroids after pediatric liver transplantation protect against T-cell–mediated rejection: Results from the ChilSFree study
Authors: Goldschmidt Imeke , Chichelnitskiy Evgeny , Götz Juliane , Rübsamen Nicole , Karch André , Jäger Veronika , Kelly Deirdre , Lloyd Carla , Debray Dominique , Girard Muriel , d’ Antiga Lorenzo , di Giorgio Angelo , Hierro Loreto , Pawlowska Joana , Klaudel-Dreszler Maja , McLin Valerie , Korff Simona , Falk Christine , Baumann Ulrich
Published: September 2023

Steroid-free immunosuppression protocols gained popularity in pediatric liver transplantation (pLT) after the introduction of IL-2–receptor blockade for induction therapy. We analyzed the clinical and immunologic outcome data of the multicenter prospective observational ChilSFree study to compare the impact of steroid-free versus steroid-containing immunosuppressive therapy following pLT in a real-life scenario. Two hundred forty-six children [55.3% male, age at pLT median: 2.4 (range: 0.2–17.9) y] transplanted for biliary atresia (43%), metabolic liver disease (9%), acute liver failure (4%), hepatoblastoma (9%), and other chronic end-stage liver diseases (39%) underwent immune monitoring and clinical data documentation over the first year after pLT. Patient and graft survival at 1 year was 98.0% and 92.7%, respectively. Primary immunosuppression was basiliximab induction followed by tacrolimus (Tac) monotherapy (55%), Tac plus steroid tapering over 3 months (29%), or cyclosporine and steroid tapering (7%). One center used intraoperative steroids instead of basiliximab followed by Tac plus mycophenolate mofetil (7% of patients). N = 124 biopsy-proven T-cell–mediated rejections were documented in n = 82 (33.3%) patients. T-cell–mediated rejection occurred early (median: 41 d, range: 3–366 d) after pLT. Patients initially treated with Tac plus steroids experienced significantly fewer episodes of rejection than patients treated with Tac alone (chi-square p<0.01). The use of steroids was associated with earlier downregulation of proinflammatory cytokines interferon (IFN)-γ, Interleukin (IL)-6, CX motif chemokin ligand (CXCL)8, IL-7, and IL-12p70. Both primary immunosuppression with Tac plus steroids and living donor liver transplantation were independent predictors of rejection-free survival 1 year after pLT on logistic regression analysis. Adjunctive steroid therapy after pLT leads to earlier suppression of the post-pLT proinflammatory response and significantly reduced rejection rates during the first year after pLT (15.9%). Fifty-one percent of patients initially treated without steroids remain steroid-free over the first 12 months without rejection.
Cystic fibrosis liver disease in the post-modulator era
Authors: Narkewicz Michael R.
Published: September 2023

Purpose of review

Highly effective modulators of cystic fibrosis transmembrane conductance regulator (CFTR) function have had dramatic impact on pulmonary and nutritional outcomes in persons with cystic fibrosis (pwCF). The impact on liver disease in pwCF was not the focus of the registration trials. The purpose of this review is to assess the current literature on the impact of HEMT on liver disease, progression, regression, and safety.

Recent findings

Short-term studies of HEMT in pwCF have shown that there is no significant impact on the frequency of liver enzyme abnormalities. There is no evidence for significant improvement in liver enzymes over time on HEMT therapy. There is conflicting data on improvement in liver fibrosis determined by fibrosis indices (APRI and GPR) or elastography. One study showed improvement, and another showed worsening in younger (<20 years old) pwCF. There are reports of resolution or improvement in hepatic steatosis. There are rare reports of severe acute hepatitis and one report of hepatic decompensation leading to liver transplantation due to drug-induced liver disease.

HEMT have not been shown to have a significant impact on improving liver disease or preventing fibrosis with short-term therapy. Longer studies are needed to assess the impact of HEMT on liver disease in pwCF.
Health anxiety and its association with perceived subjective workload in psychiatric nurses during the COVID-19 outbreak: a correlational study
Authors: Alipour Roghayeh , Golizadeh Leila , Arshadi Bostanabad Mohammad , Vahidi Maryam , Hosseinzadeh Mina , Namdar Areshtanab Hossein , Asadpour Hedi
Published: September 2023

Background:

Health care professionals, especially nurses, experience added workload, and psychological impact during the COVID-19 outbreak. This study aimed to investigate health anxiety and its association with perceived subjective workload in nurses working in psychiatric hospital wards.

Methods:

This descriptive correlational study was conducted on 206 nurses working in the psychiatric wards of Razi Psychiatry Hospital in Tabriz, Iran, in 2020–2021. Census sampling was applied and data were collected using the National Aeronautics and Space Administration Task Load Index, and the Health Anxiety Inventory. Data were analyzed using descriptive statistics,t-tests, and Pearson correlation in SPSS software version 16.

Results:

The mean (SD) of health anxiety and workload of nurses was 23/22(6/86) score range of 0–54 and 71.46 (12.37) score range of 0–100, respectively. The correlation between the mean of health anxiety and workload was significant only in the temporary dimension.

Conclusions:

Given the high workload and moderate level of health anxiety and the significant correlation between health anxiety and the temporary dimension of workload and the important role of appropriate workload in the health of nurses and the quality of nursing care, organizations and nursing managers should provide some strategies, like stuff shortage management in psychiatric wards and creating a suitable organizational culture.
Huge solitary gallstone complicated with liver cirrhosis in a middle-aged woman: case report
Authors: Chuwa Agapiti Hipoliti
Published: September 2023

Background:

Gallstones are increasingly becoming a common diagnosis in hospitals across the continents, with predominance in women. Patients suspected of a gallstone disease require thorough evaluation including endoscopic ultrasound, magnetic resonance imaging, or magnetic resonance cholangiography. A delayed or missed diagnosis is associated with serious complications and poor prognosis.

Case presentation:

A 44-year-old female patient presented with fever, vomiting, hypochondria, and epigastric pain for 10 days. Clinical examination showed jaundice and tenderness at the right hypochondriac region. Blood analysis revealed elevated bilirubin, alkaline phosphatase, and white blood cells. The patient was sent for a computed tomography (CT) scan which showed a grossly enlarged liver about 17.2 cm in length and a hypo-attenuating mass in the gallbladder fossa that enhanced moderately and heterogeneously following intravenous contrast administration. Dilated intrahepatic biliary ducts were also appreciated. Explorative laparotomy was performed and revealed an enlarged, cirrhotic-appearing liver, a thickened gallbladder, and a whitish-yellow gallstone about 3 cm in the largest diameter situated at its neck. No isolated tumour was found.

Clinical discussion:

Although gallstone disease is very common, misdiagnosis still occurs especially in low and lower-middle-income countries. Inadequate evaluation and increased utilization of CT in emergency and surgical departments are the contributing factors for a missed diagnosis.

Conclusions:

A missed gallstone disease occurs due to various factors including inappropriate standard operating procedures, which set a CT scan as the first imaging test for all internal conditions. This case report presents the appropriate approach to achieving the diagnosis of a gallstone disease before surgical intervention.
Removing 216 sharp metal foreign objects from the digestive tract of a 30-year-old male: case report
Authors: Rezazadeh Amin , Khanghah Ali Samady , Mousazadeh Siamak , Noori Farzad
Published: September 2023

Introduction and importance:

Foreign body (FB) ingestion and its complications are abundant in emergency departments. This potentially severe problem had a peak incidence in children aged 6 months to 6 years. Intentional adult cases are voluntary and more common in prisoners and people with psychiatric problems. However, most patients (90%) remain asymptomatic, and these pass through the body spontaneously.

Case presentation:

The authors report a case of surgically removing plenteous sharp-pointed metallic foreign bodies ingested by a young male deaf-mute bipolar schizoaffective patient from his stomach, intestine, and rectum. Furthermore, the authors have reviewed the available literature for similar cases.

Clinical discussion:

Less than 1% of patients need surgical removal, 10–20% need to be taken out endoscopically, and the remaining pass spontaneously. Plain radiography is the most available imaging modality detecting the number, material, and estimated place of the alimentary canal trapped.

Conclusion:

For the risk of perforation, migration, and peritonitis, surgery is indicated in such situations.
Intrapancreatic autologous stem cell therapy for type 1 diabetes – an experimental study
Authors: Jawale Sagar
Published: September 2023

Introduction:

Type 1 diabetes, also known as juvenile diabetes or insulin-dependent diabetes, is a chronic autoimmune condition in which the pancreas makes little or no insulin leading to resultant hyperglycemia. The incidence of type 1 diabetes in India is 0.26 per 1000 children.

Materials and methods:

The author treated 25 patients with type 1 diabetes with autologous intrapancreatic stem cell therapy in the last 5 years. A group of 26 patients of type 1 diabetes with conventional treatment of insulin injections was put as a control group in the same period.

Results:

The results of the therapy group were substantially superior to the control group, which came statistically highly significant. The variable compared were weight gain, the daily requirement of insulin and its drop after therapy, the rise of C-peptide levels and drop in anti-glutamic acid decarboxylase antibody, drop in HbA1c levels, and drop in fasting and postprandial blood sugar.

Discussion:

When stem cells are given intravenously, the majority are engulfed by the lungs and only a small fraction is delivered to the pancreas. When injected into the pancreas, through its arterial blood supply, due to the larger size and irregular shape of stem cells, they are retained in tissue spaces and do not escape from the venous side, thus achieving far higher concentration in the pancreas compared to the intravenous route.

Conclusions:

Intrapancreatic stem cell therapy for type 1 diabetes is safe, affordable, and effective. It has the potential to become a viable treatment option for type 1 diabetes patients.
Sociodemographic disparities associated with advanced stages and distant metastatic breast cancers at diagnosis in Indonesia: a cross-sectional study
Authors: Setyawan IG Budhi , Kurnia Dian , Setiaji Kunta , Anwar Sumadi Lukman , Purwanto Deni J. , Azhar Yohana , Budijitno Selamat , Suprabawati Desak Gede Agung , Priyono Sasongko Hadi , Siregar Bintang Abadi , Indriawan Ramses , Tripriadi Effif Syofra , Umar Mulawan , Pieter John SLA , Yarso Kristanto Yuli , Hermansyah Dedy , Wibisana IGN Gunawan , Harahap Wirsma Arif , Gautama Walta , Achmad Dimyati
Published: September 2023

Background:

The global health burden of breast cancer is increasing with 5-year survival rates being much shorter in low-income and middle-income countries. Sociodemographic and clinical disparities in early cancer detection affect long-term outcome.

Methods:

The authors compared social, demographic, and pathological characteristics associated with metastatic and late stages of breast cancer diagnosis using data collected from a special registry developed by Perhimpunan Bedah Onkologi Indonesia (PERABOI) in 2015.

Results:

Of 4959 patients recruited in this study, 995 women (20.1%) were diagnosed with metastatic breast cancer. Lower education status and living in rural areas were significantly associated with Stage IV at diagnosis [odds ratio (OR)=1.256, 95% CI=1.093–1.445, P=0.001; and OR=1.197, 95% CI=1.042–1.377, P=0.012; respectively). Main complaints other than lump (ulceration, breast pain, and discharge) and occupation as a housewife were also associated with the presentation of metastatic diseases (OR=2.598, 95% CI=2.538–3.448, P<0.001 and OR=1.264, 95% CI=1.056–1.567, P=0.030, respectively). Having lower education and living outside Java and Bali islands were associated with the diagnosis of late-stage breast cancers (OR=1.908, 95% CI=1.629–2.232, P<0.001 and OR=3.039, 95% CI=2.238–4.126, P<0.001; respectively). A higher proportion of breast cancer patients were relatively younger with bigger tumour size, positive axillary nodal involvement, and more frequent Human epidermal growth factor receptor 2 overexpression.

Conclusion:

The authors identified sociodemographic disparities in the metastatic and late-stage diagnosis of breast cancers among Indonesian women. The subsequent action is required to reduce disparities faced by women with lower social and educational levels for early diagnosis and better healthcare access.
Impacts of COVID-19 pandemic on pediatric fractures: a 4-year evaluation of epidemiology and delayed treatment from prepandemic to pandemic period at a tertiary referral hospital
Authors: Muhammad Hilmi , Magetsari Rahadyan , Rukmoyo Tedjo , Hasan Meirizal , Hidayat Luthfi , Triangga Aditya F.R. , Putro Yuni A.P. , Lanodiyu Zikrina A. , Rahayu Bernadeta F.P. , Kartika Andrea , Sakti Yudha M.
Published: September 2023

Background:

Definitive fracture surgery should be performed as soon as the patient’s condition allows. However, there may be some delays in the treatment during a pandemic.

Objective:

This study aimed to investigate and compare the epidemiology and delays in pediatric fracture management during the pandemic and prepandemic periods in terms of how many cases were delayed, how long were the delays, and the causes for the delays of fracture treatment.

Methods:

This comparative-retrospective study was conducted in a tertiary referral hospital in Yogyakarta, Indonesia. The authors included all patients who presented to the hospital from 1 December 2019 to 30 November 2021 (pandemic group period) and from 1 December 2017 to 30 November 2019 (prepandemic group period). The collected data included: patients’ age and sex, fractured bone, fracture type, concurrent fracture, hospital stay duration, treatment, need for multidisciplinary treatment, interval from arrival to treatment, and reasons for delayed surgical treatment. The data were obtained from the patients’ medical records.

Results:

Results showed a decrease in the pediatric fracture cases during the 2 years pandemic period compared to the prepandemic period (75 vs. 135 cases). There was no significant difference in the evaluated parameters of demographic, fractured bone and type, hospital stay duration, treatment, other department involvement, and delayed surgical treatment for the fracture. The most common reason for the definitive surgical management delay was the need for medical condition improvements (n=63, 79.7%) and it was significantly associated with the need for multidisciplinary treatment approach (22.83 in isolated orthopedic cases vs. 87.5% in multidisciplinary cases; P=0.000).

Conclusion:

There was a decrease in the pediatric fracture cases during the 2-year pandemic period compared to the prepandemic period. The delay in definitive surgical management was mainly due to the need for the medical condition improvements and it was associated with the need for a multidisciplinary treatment approach.
Endovenous laser ablation versus conventional surgery (ligation and stripping) for primary great saphenous varicose vein: a systematic review and meta-analysis
Authors: Shrestha Oshan , Basukala Sunil , Thapa Niranjan , Karki Sagun , Pant Prashant , Paudel Sushanta
Published: September 2023

Background:

The great saphenous varicose vein was managed with high ligation and stripping conventionally, but with the development of minimally invasive surgical techniques like endovascular laser ablation (EVLA), they have become popular. This systematic review and meta-analysis of randomized controlled trials aim to compare the short-term and long-term outcomes of these two modalities on headings like procedural time, technical success, recovery time, recurrences, cost-effectiveness, and complications.

Materials and methods:

The protocol followed in this study was registered prospectively in the Registry of Systematic Reviews/Meta-analyses. Electronic databases were searched with appropriate search terms for relevant studies, and after their screening, data was extracted. The odds ratio was used for dichotomous data, and the mean difference or standardized mean difference was used for continuous variables.

Results:

This study identified 18 publications (10 randomized controlled trials) with a total of 1936 patients. There was no difference in procedural time, recovery time, recurrences at 1, 2, and 5 years, or clinical severity score. The surgery group had 4.35 times higher statistically significant odds of being technically successful at 2 years, while pooling data on bruising, hematoma, sensory disturbance, infection, and phlebitis showed that the EVLA group was less likely to develop postoperative complications.

Conclusion:

Technical failures were more common in the EVLA, whereas postoperative complications were more common in the surgery group. Both have comparable clinical effectiveness, and neither modality has clear superiority over the other. Parameters like cost-effectiveness must be assessed at the hospital level before choosing the right procedure for the patients.
Avascular necrosis of femoral head following COVID-19 infection
Authors: Assad Saywan K. , Sabah Mohammed , Kakamad Fahmi H. , Salih Abdulwahid M. , Salih Rawezh Q. , Mohammed Shvan H. , Ali Razhan K. , Abdalla Berun A. , Hassan Marwan N.
Published: September 2023

Introduction:

It is crucial to be aware of post-COVID-19 non-pulmonary complications. Avascular necrosis (AVN) is one of these complications. It should be noted that the risk of AVN persists in individuals who have recovered from the COVID-19 infection. The current study aims to report several cases of AVN after being infected with SARS-CoV-2.

Materials and methods:

This is a single-centre retrospective case series conducted over a 2-year period (January 2021–December 2022) involving individuals who developed AVN after being infected with COVID-19.

Result:

The study included a total of 17 patients. The mean age of patients was 38.65±6.1 years. Twelve of them were male (70.6%) and five were female (29.4%), with a ratio of 3:1. The mean BMI of the patients was 28.3±2.4 kg/m2. Eleven (64.7%) patients reported administering steroid injections throughout the infection course. The mean interval between COVID-19 infection and presentation to the clinic was 6.53 months. The majority of patients (82.3%) complained of bilateral hip pain. Limping was observed in 47% of the cases. MRI showed AVN in all cases. Bilateral core decompression was performed in five cases (29.4%), total hip replacement in three cases (17.6%), and conservative treatment in nine cases (53%).

Conclusion:

The ongoing pandemic may have many long-term sequelae. There is a risk of developing AVN after COVID-19.
Giant condyloma acuminatum surgical management: a case report and literature review
Authors: Al-Ghamdi Ahmed M. , Alfalah Seba , Anwer Khurshid , Alzaher Ibrahim , Alsuhaimi Ahmed A. , Aldhafeeri Sahar M.
Published: September 2023

Introduction and importance:

Condyloma acuminatum (CA) or genital warts, represents a rare sexually transmitted disease caused by the human papillomavirus. Infection occurs when host basal cells are exposed to viral infection through a damaged epithelial barrier, during sexual intercourse, or due to other minor skin abrasions. Giant condyloma acuminatum (GCA) has a higher rate of malignant transformation than CA.

Case presentation:

We are presenting a 44-year-old single gentleman known as a smoker, hepatitis B positive, vitiligo, and hypercholesteromia. He was an alcoholic and had multiple heterosexual relationships abroad. Referred from the dermatology clinic, complaining of genital warts that had increased in size for 10 years.

Clinical discussion:

CA management includes local applications like imiquimod and podophyllotoxin and clinician-administered treatments such as cryotherapy, surgical excision, electrosurgery, and CO2 laser therapy. Other options, such as interferon, radiotherapy, or chemotherapy, are available. The selection of therapy should be individualized and based upon consideration of the extent of the disease, patient preference, cost, adverse effects, treatment availability, and the response to previous treatments. Complete surgical excision is the treatment of choice for GCA.

Conclusion:

We present a patient with GCA in the perianal area that was surgically treated with an excellent outcome.
Prevalence and impact of diabetes mellitus in hospitalized COVID-19 patients in a Tunisian Center: a cross-sectional study
Authors: Rouis Sana , Chebil Dhekra , Debbabi Wided , Hannachi Hajer , Sakly Hela , Chermiti Sondes , Marzouk Hajer , Kharrat Issam , Samet Slim , Merzougui Latifa
Published: September 2023

Background:

The outbreak of the coronavirus disease 2019 (COVID-19) has become an evolving worldwide health crisis. With the rising prevalence of diabetes mellitus has come an increasing awareness of their impacts on infectious diseases, and the risk for postinfection complications and mortality from critical infections.

Objective:

The objective of this study was to evaluate the prevalence and impact of diabetes mellitus on the severity and mortality of COVID-19.

Methods:

Data of laboratory-confirmed hospitalized patients at the COVID-19 unit between September 2020 and August 2021 were analyzed, in a cross-sectional study. The population was classified into two groups: COVID-19 patients with and without diabetes. Primary outcomes were the overall length of hospital stay, the admission to the ICU, and death. The association between diabetes and death was assessed in a Cox proportional hazards model.

Results:

A total of 866 patients were included. There were 270 (31.2%) patients with diabetes. Diabetic patients were more likely to have hypertension (58.1 vs. 33.4%), cardiovascular disease (18.5 vs. 10.4%), and dyslipidaemia (17.8 vs. 7.2). Overall, 263 patients died, among them only 86 in the diabetic group (P=0.523). Patients with diabetes had a higher risk of developing complications (P<0.001). Multivariate Cox regression analysis showed that diabetes was not significantly associated with death [HR (95% CI): 1.253 (0.963–1.631)].

Conclusion:

Diabetes was associated with a greater risk of complications in patients with COVID-19. Special attention to diabetic patients during treatment must be given to avoid these complications.
The promise of RNA-based therapeutics in revolutionizing heart failure management – a narrative review of current evidence
Authors: Aderinto Nicholas , Abdulbasit Muili O. , Olatunji Gbolahan , Edun Mariam , Aboderin Gbolahan
Published: September 2023

This review elucidates the potential of RNA-based therapeutics to revolutionize heart failure (HF) management. Through a comprehensive analysis of relevant studies, this review reveals the promising prospects of these novel interventions in personalized treatment strategies, targeted modulation of specific molecular pathways, and the attainment of synergistic effects via combination therapies. Moreover, the regenerative capacity of RNA-based therapeutics for cardiac repair and the inherent advantages associated with noninvasive routes of administration are explored. Additionally, the studies accentuate the significance of diligent monitoring of disease progression and treatment response, ensuring safety and considering long-term outcomes. While ongoing research endeavours and technological advancements persist in addressing extant challenges and limitations, the transformative potential of RNA-based therapeutics in HF management offers a beacon of hope for enhanced patient outcomes.
Digital Collateral Information Through Electronic and Social Media in Psychotherapy: Comparing Clinician-reported Trends Before and During the COVID-19 Pandemic
Authors: Vahia Ipsit V. , Sava Rachel N. , Cray Hailey V. , Kim Heejung J. , Dickinson Rebecca A. , Ressler Kerry J. , Trueba Ana F.
Published: September 2023

Background:

Patient clinical collateral information is critical for providing psychiatric and psychotherapeutic care. With the shift to primarily virtual care triggered by the COVID-19 pandemic, psychotherapists may have received less clinical information than they did when they were providing in-person care. This study assesses whether the shift to virtual care had an impact on therapists’ use of patients’ electronic and social media to augment clinical information that may inform psychotherapy.

Methods:

In 2018, we conducted a survey of a cohort of psychotherapists affiliated with McLean Hospital. We then reapproached the same cohort of providers for the current study, gathering survey responses from August 10, 2020, to September 1, 2020, for this analysis. We asked clinicians whether they viewed patients’ electronic and social media in the context of their psychotherapeutic relationship, what they viewed, how much they viewed it, and their attitudes about doing so.

Results:

Of the 99 respondents, 64 (64.6%) had viewed at least 1 patient’s social media and 8 (8.1%) had viewed a patient’s electronic media. Of those who reported viewing patients’ media, 70 (97.2%) indicated they believed this information helped them provide more effective treatment. Compared with the 2018 prepandemic data, there were significantly more clinicians with>10 years of experience reporting media use in therapy. There was also a significant increase during the pandemic in the viewing of media of adult patients and a trend toward an increase in viewing of media of older adult patients.

Conclusions:

Review of patients’ electronic and social media in therapy became more common among clinicians at a large psychiatric teaching hospital during the COVID-19 pandemic. These findings support continuing research about how reviewing patients’ media can inform and improve clinical care.
Acute Treatment of Adolescent Cannabinoid Hyperemesis Syndrome With Haloperidol, Lorazepam, and/or Capsaicin: A Single Institution Case Series
Authors: Brown Jerry M. , Wilsey Michael J. , Dhana Leila , Lonsdale Hannah
Published: September 2023

Cannabinoid hyperemesis syndrome (CHS), an under-recognized and seemingly paradoxical condition, arises in some adolescents and adults who chronically use cannabis. It presents acutely with intractable nausea, vomiting, and abdominal pain but standard antiemetic therapy leads to improvement for only a minority of patients. Randomized controlled trial evidence in adults indicates the superiority of haloperidol over ondansetron in alleviating the acute symptoms of CHS, but safe and effective treatment for adolescents with the disorder is currently unknown. The successful use of topical capsaicin has also been reported. We report a case series of 6 adolescent patients with CHS who presented to Johns Hopkins All Children’s Hospital and were treated with haloperidol, lorazepam, and/or capsaicin. Four patients given 5 mg intravenous (IV) haloperidol and 2 mg IV lorazepam and 1 patient treated with 5 mg IV haloperidol and peri-umbilical topical capsaicin (0.025%) experienced full acute symptomatic relief. One patient, treated only with topical capsaicin, reported improvement of symptoms with some persistent nausea. Haloperidol/lorazepam, haloperidol/capsaicin, and topical capsaicin alone appear safe and effective in adolescents, but larger studies are required to confirm our findings.
The Triple “S” Impact of COVID-19: Nationwide Evidence of the Impact of the Stress Associated With Restrictive Measures on Substance Use, Sleep, and Social Connectedness in Qatar
Authors: Abed Alah Muna , Abdeen Sami , Kehyayan Vahe , Bougmiza Iheb
Published: September 2023

Objectives:

Countries worldwide implemented social and movement restrictions to contain the spread of coronavirus disease 2019 (COVID-19). Unfortunately, such restrictions have adversely impacted people’s lifestyles. The goal of this study was to assess the impact of COVID-19-related restrictive measures on substance use, sleep, and social connectedness in Qatar’s population.

Methods:

A web-based survey was conducted between January 2021 and February 2021 targeting adults ≥18 years of age who were residing in Qatar between March and August 2020.

Results:

A total of 1408 participants completed the survey. Of tobacco users in our sample, 36% reported increased tobacco use since the start of home confinement, while 41.6% of alcohol users reported decreased alcohol use. Concerning sleep, 46.1% reported an increase in average sleep duration per day (0.77 h mean increase, 95% CI: 0.66-0.88, P<0.001), and a third of participants reported poorer sleep quality. Of the participants, 39.6% felt socially disconnected. Perceived stress was found to be an independent predictor for increased use of tobacco, deterioration in sleep quality, and increased sleep duration during home confinement.

Conclusions:

Restrictive measures related to COVID-19 resulted in both positive and negative impacts on the lifestyle of Qatar’s population. Emphasis should be placed on encouraging people to adopt healthy strategies for coping with various stressors that arise during future home confinement measures. It is also necessary to address the persistence of adverse consequences in the postpandemic era.
Survival After Simultaneous Heart-kidney Transplant in Recipients With a Durable LVAD and Chronic Kidney Disease: Effect of the 2018 Heart Allocation Policy Change
Authors: Fraser Meg , Agdamag Arianne C. , Riad Samy , Nzemenoh Bellony N. , Jackson Scott , Money Joel , Knoper Ryan , Martin Cindy M. , Alexy Tamas
Published: September 2023

Background.

Heart transplantation remains the most definitive therapy for qualified candidates with end-stage heart failure. Concomitant kidney disease is common in this population prompting an increase in simultaneous heart-kidney (SHK) transplantation in recent years. The goal of our study was to explore the effects of the 2018 heart allocation policy (HAP) change on candidate listing characteristics and compare survival rates at 1 y in patients that were supported with a left ventricular assist device (LVAD) pretransplant and underwent SHK or heart alone transplant (HAT).

Methods.

We used data from the Scientific Registry of Transplant Recipients and identified all adults who underwent primary SHK or HAT between January 2010 and March 2022. Recipients supported with a durable LVAD and estimated glomerular filtration rate <60 mL/min/1.73 m2 were selected (n = 309 SHK; 217 pre- and 92 post-HAP and n = 3,324 HAT; 2738 pre- and 586 post-HAP).

Results.

Difference in survival at 1 y did not reach statistical significance. Comparing the 1-y survival of SHK and HAT recipients who were bridged with LVAD pre-HAP, we found no significant difference (P = 0.694). Adjusting for the same covariates in a multivariable model did not affect the results (SHK versus HAT hazard ratio 0.84 [0.51, 1.37]; P = 0.48). In contrast, SHK recipients supported with an LVAD who were listed and transplanted post-HAP change had significantly lower 1-y survival, when compared with HAT (P = 0.037).

Conclusions.

Our findings suggest that the HAP change had a potentially negative impact on the survival of select patients undergoing SHK transplant. Further research is warranted in this area.
Spring temperature drives phenotypic selection on plasticity of flowering time
Authors: Valdés Alicia , Arnold Pieter A. , Ehrlén Johan
Published: September 2023

In seasonal environments, a high responsiveness of development to increasing temperatures in spring can infer benefits in terms of a longer growing season, but also costs in terms of an increased risk of facing unfavourable weather conditions. Still, we know little about how climatic conditions influence the optimal plastic response. Using 22 years of field observations for the perennial forest herb
Lathyrus vernus
, we assessed phenotypic selection on among-individual variation in reaction norms of flowering time to spring temperature, and examined if among-year variation in selection on plasticity was associated with spring temperature conditions. We found significant among-individual variation in mean flowering time and flowering time plasticity, and that plants that flowered earlier also had a more plastic flowering time. Selection favoured individuals with an earlier mean flowering time and a lower thermal plasticity of flowering time. Less plastic individuals were more strongly favoured in colder springs, indicating that spring temperature influenced optimal flowering time plasticity. Our results show how selection on plasticity can be linked to climatic conditions, and illustrate how we can understand and predict evolutionary responses of organisms to changing environmental conditions.