bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Corneal Thickness Measurements After Customized Corneal Crosslinking Using High-Resolution Optical Coherence Tomography and Scheimpflug Tomography
Authors: Mendes Baiao Tiago , Wendelstein Jascha , Seiler Theo G.
Published: February 2023

Purpose:

The aim of this study was to compare the evolution of corneal pachymetry after customized corneal crosslinking (CXL) between Scheimpflug-based and optical coherence–based corneal tomography (OCT).

Methods:

In this retrospective study, central corneal thickness (CCT), thinnest corneal thickness, and epithelial thickness of 33 eyes of 33 patients with keratoconus were measured preoperatively and 1, 3, and 12 months after customized CXL using the Pentacam HR and the MS-39. The mean pachymetry values of measurements were compared with a paired sample t test. Bland–Altman plots and 95% limits of agreement (LoA) were used to assess the agreement between the measurements of the 2 devices.

Results:

The mean age of the participants was 29.7 ± 11.4 years. At baseline, the mean CCT measurements were equal with Pentacam HR (478.30 ± 36.77 μm) and MS-39 (478.46 ± 38.01 μm). After CXL, CCT obtained by Pentacam HR was 460.65 ± 38.69 μm, 464.65 ± 44.45 μm, and 476.77 ± 39.85 μm, and by MS-39 was 478.18 ± 39.50 μm, 472.89 ± 40.92 μm, and 479.51 ± 39.20 μm at 1, 3, and 12 months, respectively. Pentacam HR measured significantly lower CCT (P < 0.05) at months 1 and 3 after CXL. The agreement was smallest between both devices at month 1 (95% LoA −59 to 24 μm) followed by month 3 (95% LoA: −41 to 23 μm). Epithelial thickness, measured with OCT alone, increased significantly at 1 month and regained preoperative levels at 3 months and thereafter.

Conclusions:

After CXL, corneal pachymetry significantly differs between OCT-based and Scheimpflug-based corneal tomography. Pentacam HR seems to underestimate pachymetry when haze is present.
Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease: A Diagnostic Accuracy Study for Pediatric Tuberculosis
Authors: Olbrich Laura , Nliwasa Marriott , Sabi Issa , Ntinginya Nyanda E. , Khosa Celso , Banze Denise , Corbett Elizabeth L. , Semphere Robina , Verghese Valsan P. , Michael Joy Sarojini , Graham Stephen M. , Egere Uzochukwu , Schaaf H. Simon , Morrison Julie , McHugh Timothy D. , Song Rinn , Nabeta Pamela , Trollip Andre , Geldmacher Christof , Hoelscher Michael , Zar Heather J. , Heinrich Norbert ,   on behalf of the RaPaed-AIDA-TB Consortium
Published: February 2023

Introduction:

An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study.

Methods:

This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor’s and all relevant local ethics committees.

Discussion:

As a diagnostic accuracy study for a disease with an imperfect reference standard, Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB) was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB.
Clinical Characteristics of Pulmonary Tuberculosis in Children Tested by Xpert MTB/RIF Ultra
Authors: Quan Shuting , Zou Tingting , Duan Li , Tian Xue , Wang Yacui , Zhu Yu , Fang Min , Shi Yan , Wan Chaomin , Sun Lin , Shen Adong
Published: February 2023

Background:

The Xpert MTB/rifampicin Ultra (Xpert Ultra) assay improves the early diagnosis of active tuberculosis (TB) in children. Clinical evaluation is paramount for the interpretation of any positive Xpert Ultra test, especially those with low quantities of DNA.

Methods:

In this study, 391 children with suspected TB who were tested with Xpert Ultra were enrolled. The clinical characteristics and Xpert Ultra results were further analyzed.

Results:

The sensitivity and specificity of Xpert Ultra were 45.0% (149/331) and 96.7% (58/60), respectively. Children with higher semiquantitative scales of Xpert Ultra showed higher percentages of a positive MTB culture, positive acid-fast bacilli staining, severe type of disease, fever, cough and expectoration, a higher white blood cell count and higher C-reactive protein concentrations (all P < 0.01). Among 44 children with an Xpert Ultra trace result, there were no differences in clinical characteristics between confirmed cases and unconfirmed TB cases.

Conclusions:

The prevalence of trace is relatively high and can be considered positive in paucibacillary children. Clinical presentations are associated with bacterial load quantified by Xpert Ultra. The interpretation of Xpert Ultra trace results based on clinical information is important for the diagnosis of TB.
Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases
Authors: Al Dhaheri Fatima A. , El Dannan Huda , Hashim Muhammad Jawad , Alshehi Shooq , Al-Jburi Farah , Antali Aisha , Al Jasmi Noora , Al Khouri Shaima , Al Hajjar Mohamad , Abbas Thikra , ElGhoudi Ahmed , Al Hassani Moza
Published: February 2023

Background:

The literature describing clinical presentation, disease course and outcomes of SARS-CoV-2 in infants remains scarce.

Methods:

We conducted a retrospective study across 2 major pediatric referral centers evaluating the demographics, clinical and laboratory characteristics, management and outcomes of COVID-19 among newborns and infants in the United Arab Emirates (UAE). Clinical and biochemical markers were evaluated for their accuracy in predicting intensive care unit (ICU) transfer and death.

Results:

A total of 576 COVID-19-positive infants were evaluated with a mean age of 164 days. The mean duration of symptoms was 1.48 days. Fever was present in 36.5% of the cohort, while 44.3% had nasal congestion. Eight infants (of 575; 1.39%) required transfer to the ICU for impending respiratory failure and 2 required invasive ventilation. Symptomatic (fever, nasal congestion) infants were not more likely to be transferred to the ICU (Chi-squared test, P = 0.77). ICU transfer was associated with a higher chance of receiving antibiotics (70.6% vs 35.4%; Chi-squared test, P = 0.003). On multivariate analysis, none of the clinical parameters (age, symptoms, laboratory tests) predicted transfer to the ICU. No deaths were reported during the observation period.

Conclusions:

Infants with SARS-CoV-2 infection have a benign clinical course with favorable outcomes. Less than 2% require ICU transfer. Clinical vigilance is required as none of the admission parameters predicted ICU transfer.
Outcomes in Pediatric Central Line–associated Bloodstream Infections Treated With Antimicrobial Locks: A 14-Year Retrospective Analysis
Authors: Walker Lorne W. , Visweswaran Shyam , Nowalk Andrew J.
Published: February 2023

Background:

Central line–associated bloodstream infections (CLABSI) are the most common healthcare-associated infection in children. Antimicrobial lock therapy (ALT) is a recommended component of CLABSI treatment; however, studies characterizing pediatric ALT-based CLABSI therapy are few.

Methods:

All CLABSI treated with ALT at a single tertiary-care pediatric hospital for years 2004–2018 were identified by retrospective chart review and demographic, clinical, microbiological and pharmacy data were extracted. Three clinical outcomes were defined: CLABSI clearance, central venous catheter (CVC) removal and infection recurrence. Factors associated with these outcomes were examined and patterns in pathogen occurrence were described.

Results:

During the study period, 1188 CLABSI treated with ALT were identified. In all, 969 (85%) CLABSI initially cleared. In the CLABSI with initial clearance, CVCs were retained a median of 63 days after infection onset, and 20% recurred. Skin-colonizing microbes (Staphylococcus aureus, coagulase-negative Staphylococci) were more likely to produce monomicrobial infections, whereas bowel-colonizing microbes (Escherichia coli, Enterococci) were more associated with polymicrobial infections. In a multivariate model, infection history, resistant pathogens and CVC type were strongly correlated with infection recurrence, whereas bone marrow transplant status, neutrophil count and line type were correlated with CVC removal.

Conclusions:

Optimal therapeutic approaches to pediatric CLABSI remain uncertain, including the utility of ALT. Prior reports of ALT use in children have been smaller in size and largely described hematology-oncology or hemodialysis populations. We describe trends in pediatric CLABSI, including efficacy among solid organ transplant recipients and children with short-gut syndrome. These data provide guidance on selecting CLABSI for optimal ALT use.
An early report of exoscope-assisted otologic surgery
Authors: Zhang Bang-Yan , Ho Valerie Wai-Yee , Tsai Tzong-Yun , Chan Kai-Chieh
Published: February 2023

Background:

Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution.

Methods:

Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed.

Results:

Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty.

Conclusion:

Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.
Canadian Academy of Sport and Exercise Medicine Position Paper: The Clinician’s Role in Addressing and Preventing Maltreatment in Sport—10-year Anniversary
Authors: Stirling Ashley E. , Taylor Anika R. , Mountjoy Margo L. , Cruz E. Laura , Bridges Eileen J.
Published: February 2023

In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care.
Return to Sport after Arthroscopic Rotator Cuff Repair of Full-Thickness Rotator Cuff Tears: A Systematic Review
Authors: Alben Matthew G. , Gambhir Neil , Papalia Aidan G. , Bostrom Nicholas , Larose Gabriel , Virk Mandeep S. , Rokito Andrew S.
Published: February 2023

Objective:

Perform a systematic literature review regarding return to sport (RTS) outcomes after arthroscopic rotator cuff repair (aRCR) for full-thickness rotator cuff tears (FTRCTs).

Data Sources:

Systematic review of all articles in PubMed, Medline, and Excerpta Medica Database (EMBASE) was conducted in April 2022 using a combination of keywords: “rotator cuff repair,” “RCR,” “complete,” “full-thickness,” “tear,” “RCT,” “injury,” “shoulder,” “arthroscopic,” “return to sport,” “RTS,” “sport,” “return to play,” and “athlete.” Cohorts were included from all articles reporting RTS after aRCR for FTRCTs. Studies that were non-English, failed to distinguish between partial and FTRCT outcomes, or treated FTRCTs by open RCR, mini-open RCR, debridement, or nonsurgical management were excluded. Abstracted data included study design, surgical techniques, concomitant procedures, demographics, FTRCT type and size, patient-reported outcomes, type of sport, competition level, time to return, and reasons for failing to RTS.

Main Results:

11 studies were reviewed, with inclusion of 463 patients (385 athletes; mean age 47.9). RTS varied considerably in rate and timing, with 50.0% to 100% of patients returning on average between 4.8 to 14 months. In addition, 31 patients returned to a higher level of sport, 107 returned to or near preinjury level, and 36 returned to a lower level of competition or failed to RTS entirely.

Conclusions:

The ability for athletes to RTS after aRCR for FTRCTs is likely multifactorial, demonstrating high variability in return rates and time to RTS. Given the paucity of available literature, future studies are warranted to provide a more definitive consensus.
Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players
Authors: Saw Anna , Eales Brent , Jones Nick , Obst Alan , Smith Martin , Kountouris Alex , Saw Richard
Published: February 2023

Objective:

To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players.

Design:

Retrospective case series.

Setting:

Professional domestic and international cricket teams over 13 seasons.

Participants:

Elite Australian cricket players.

Independent variables:

Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging.

Main outcome measures:

Incidence, presentation, history, healing, and management.

Results:

211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis.

Conclusions:

LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.
In Vitro Testing of Trichomonas vaginalis Drug Susceptibility: Evaluation of Minimal Lethal Concentrations for Metronidazole and Tinidazole That Correspond With Treatment Failure
Authors: Augostini Peter , Bradley Erin L. P. , Raphael Brian H. , Secor W. Evan
Published: February 2023

Background

The only drugs approved by the US Food and Drug Administration for oral treatment of trichomoniasis belong to the 5-nitroimidazole group. Most individuals infected with Trichomonas vaginalis can be cured with a standard treatment of metronidazole or tinidazole, but it is estimated that more than 159,000 people fail treatment each year. Although a minimal lethal concentration (MLC) corresponding to treatment failure has been reported for metronidazole, the MLC for tinidazole associated with treatment failure has not been determined. We conducted a study using T. vaginalis isolates from women with reported treatment success or failure to determine these values.

Methods

We measured MLCs of 47 isolates obtained from women who had failed metronidazole treatment, 33 isolates from women who had failed tinidazole treatment, and 48 isolates from women successfully cured with metronidazole. The cutoff was calculated as the 95th percentile of MLCs of susceptible isolates for each drug.

Results

Our data confirmed that the MLC previously associated with metronidazole treatment failure is ≥50 μg/mL and identified the MLC associated with tinidazole treatment failure as ≥6.3 μg/mL. For metronidazole, the agreement between laboratory result and treatment outcome was 93.7%; for tinidazole, this agreement was 88.9%.

Conclusions

The T. vaginalis susceptibility assay is useful for determining whether 5-nitroimidazole treatment failure in persons with trichomoniasis can be attributed to drug resistance. These results are useful for establishing interpretive guidance of test results, and MLC levels can help guide appropriate patient treatment.
A Case of Cyclic Vomiting Syndrome-Induced Hypertension Causing Posterior Reversible Encephalopathy Syndrome
Authors: Beckman Madeline , Lendner Nuphar , Sferra Thomas J. , Moses Jonathan
Published: February 2023

Cyclic vomiting syndrome (CVS) is characterized by repeated episodes of vomiting in a stereotyped pattern and is a known cause of hypertension. Our patient is a 10-year-old female who presented with nonbilious, nonbloody vomiting, and constipation concerning for a flare of her known CVS. During the hospital course, she developed intermittent severe hypertensive episodes, leading to an acute episode of altered mental status and a tonic-clonic seizure. Magnetic resonance imaging confirmed diagnosis of posterior reversible encephalopathy syndrome (PRES) after eliminating other organic etiologies. This is one of the first documented cases of CVS-induced hypertension causing PRES.
Improving the Quality of Maternity Care: Learning From Malpractice
Authors: Shi Meihong , Zhang Hua , Huang Siyuan , Zhang Mingfeng , Hu Xiuying
Published: February 2023

Objective

This study aimed to depict the characteristics, injury outcomes, and payment of obstetric malpractice lawsuits to better understand the medicolegal burden in obstetrics and categorize the causes of obstetric malpractice lawsuits using The National Health Service Litigation Authority coding taxonomy for further quality improvement in maternity care.

Methods

We reviewed and retrieved key information on court records of legal trials from China Judgment Online between 2013 and 2021.

Results

A total of 3441 obstetric malpractice lawsuits successfully claimed were reviewed in this study, with a total indemnity payment of $139,875,375. After peaking in 2017, the number of obstetric malpractice claims begins to decline. Of the 2424 hospitals that were sued, 8.3% (201/2424) were referred to as “repeat defendant” because they were involved in multiple lawsuits. Death and injury were the outcomes in 53.4% and 46.6% of the cases, respectively. The most common outcome type was neonatal death, which made up 29.8% of all cases. The median indemnity payment for death was higher compared with injury (P < 0.05). In terms of detailed injury outcomes, the major neonatal injury had higher median indemnity payments than neonatal death and fetal death (P < 0.05). The median indemnity payment of the major maternal injury was higher than that of maternal death (P < 0.05). The leading causes of obstetric malpractice were the management of birth complications and adverse events (23.3%), management of labor (14.4%), career decision making (13.7%), fetal surveillance (11.0%), and cesarean section management (9.5%). The cause for 8.7% of cases was high payment (≥$100, 000). As indicated by the results of the multivariate analysis, the hospitals in the midland of China (odds ratio [OR], 0.476; 95% confidence interval [CI], 0.348–0.651), the hospitals in the west of China (OR, 0.523; 95% CI, 0.357–0.767), and the secondary hospitals (OR, 0.587; 95% CI, 0.356–0.967) had lower risks of high payment. Hospitals with ultimate liability (OR, 9.695; 95% CI, 4.072–23.803), full liability (OR, 16.442; 95% CI, 6.231–43.391), major neonatal injury (OR, 12.326; 95% CI, 5.836–26.033), major maternal injury (OR, 20.885; 95% CI, 7.929–55.011), maternal death (OR, 18.783; 95% CI, 8.887–39.697), maternal death with child injury (OR, 54.682; 95% CI, 10.900–274.319), maternal injury with child death (OR, 6.935; 95% CI, 2.773–17.344), and deaths of both mother and child (OR, 12.770; 95% CI, 5.136–31.754) had higher risks of high payment. In the causative domain, only anesthetics had a higher risk of high payment (OR, 5.605; 95% CI, 1.347–23.320), but anesthetic-related lawsuits made up just 1.4% of all cases.

Conclusions

The healthcare systems had to pay a significant amount as a result of obstetric malpractice lawsuits. Greater efforts are required to minimize serious injury outcomes and improve obstetric quality in the risky domains.
Proactive Patient Safety: Focusing on What Goes Right in the Perioperative Environment
Authors: Duffy Caoimhe , Menon Neil , Horak David , Bass Geoffrey D. , Talwar Ruchika , Lorenzi Cara , Taing Vo Christina , Chaing Chienhui , Ziemba Justin B.
Published: February 2023

Objective

Adverse events in the perioperative environment, a potential risk to patients, may be mitigated by nurturing staff adaptability and resiliency. An activity called “One Safe Act” (OSA) was developed to capture and highlight proactive safety behaviors that staff use in their daily practice to promote safe patient care.

Methods

One Safe Act is conducted in-person in the perioperative environment by a facilitator. The facilitator gathers an ad hoc group of perioperative staff in the work unit. The activity is run as follows: staff introductions, purpose/instructions of the activity, participants self-reflect about their OSA (proactive safety behavior) and record it as free text in an online survey tool, the group debriefs with each person sharing their OSA, and the activity is concluded by summarizing behavioral themes. Each participant completed an attitudinal assessment to understand changes in safety culture perception.

Results

From December 2020 to July 2021, a total of 140 perioperative staff participated (21%, 140/657) over 28 OSA sessions with 136 (97%, 140/136) completing the attitudinal assessment. A total of 82% (112/136), 88% (120/136), and 90% (122/136) agreed that this activity would change their practices related to patient safety, improve their work unit’s ability to deliver safe care, and demonstrated their colleagues’ commitment to patient safety, respectively.

Conclusions

The OSA activity is participatory and collaborative to build shared, new knowledge, and community practices focused on proactive safety behaviors. The OSA activity achieved this goal with a near universal acceptance of the activity in promoting an intent to change personal practice and increasing engagement and commitment to safety culture.
Prevention and treatment of recurrent cellulitis
Authors: Peghin Maddalena , Graziano Elena , Rovelli Cristina , Grossi Paolo Antonio
Published: February 2023

Purpose of review

Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of literature evidence and to highlight recent developments in its management.

Recent findings

Recurrent cellulitis can occur after successful treatment of cellulitis. Conditions that commonly increase the risk of cellulitis include local and systemic modifiable and nonmodifiable factors. A rigorous approach to the management of risk factors and treatment of acute infection is important as the risk of recurrence rises with repeated episodes. Risk factors, if present, need to be targeted in association with antibiotic prophylaxis. Penicillin V is the preferred antibiotic for prevention but other antibiotics and new drugs can be considered in cases of β-lactam allergy, intolerance, or failure.

Recurrent cellulitis is associated with short term and long-term morbidity as well as significant healthcare costs. Management of underlying predisposing conditions is crucial to prevent recurrence in addition with evaluation of pharmacological measures, but specialized and multidisciplinary skills are needed. More efforts are needed to prevent and treat this underestimated problem.
Postoperative Nasal Conformers in Cleft Rhinoplasty: Are They Efficacious?
Authors: Rossell-Perry Percy , Romero-Narvaez Carolina , Gavino-Gutierrez Arquimedes , Figallo-Hudtwalcker Olga
Published: February 2023

Background:

Lip and nose symmetry the goal of repair of unilateral cleft lip and different preoperative and postoperative treatments have been developed with this purpose. The objective of this study was to compare 2 techniques used for primary cleft lip nose repair.

Materials and Methods:

This is an retrospective study between 2 groups of patients with unilateral cleft lip and palate who underwent primary nasolabial repair either with or without postoperative nasal conformers. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements under general anesthesia during primary cleft palate repair.

Results:

Our comparative study did not find a statistically significant difference regarding percentile indexes of nasal asymmetry between the 2 groups. Major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 3.84% of nasal conformer group and 4.65% of the group without nasal conformers.

Conclusions:

The results obtained from this study provides showed that placement of postoperative nasal conformers did not improve nasal symmetry in patients with unilateral cleft lip and palate. Based on these findings and available scientific evidence, definitive conclusions about the effectiveness of these devices on nasal symmetry after unilateral cleft lip nose repair cannot be drawn.
Malposition of the Resorbable Sheet in Medial Orbital Wall Fractures: Frequency and Techniques for Prevention
Authors: Hwang Kun , Ma Sung Hwan
Published: February 2023

The aim of this report is to discuss malposition of the resorbable sheet in medial orbital wall fractures and how to prevent this problem. After making an incision through the skin and orbicularis oculi muscle, a skin-muscle flap was elevated just superficial to the orbital septum, extending to the arcus marginalis. Dissection was extended just below the anterior lacrimal crest to increase the exposure. Fracture site in medial orbital wall was visualized. A resorbable sheet (poly-l-lactide, d-lactide sheet, 0.5-mm thickness) was trimmed and molded in an L shape, with the vertical portion used to cover the medial wall defect and the horizontal portion for stability in the orbital floor. An extended part, measuring roughly 1 cm, was bent across on the infraorbital rim, and this part was fixed with absorbable screws to prevent the sheet from crumpling. After the molded plate was put in position, the periosteum and skin were closed. From 2011 to 2021, the authors operated on 152 orbital floor or medial wall fractures. Among 152 patients who underwent surgery to reconstruct orbital floor or medial wall fracture, of whom 27 patients had both floor and medial wall fractures, the authors experienced 2 cases of medial orbital wall fractures where the resorbable sheet was malpositioned, requiring reoperation. To prevent malposition of the sheet in medial wall reconstruction, the inferomedial angle of the vertical portion and the horizontal portion of the sheet should be about 135°. Before fixing the sheet on the bony part, a complete tension-free forced-duction test is mandatory.
CAN POLYETHYLENE GLYCOL-20K REPLACE ALBUMIN FOR PREHOSPITAL TREATMENT OF HEMORRHAGIC SHOCK WHEN FULL RESUSCITATION IS UNAVAILABLE?
Authors: Xiang Lusha , Calderon Alfredo S. , Ryan Kathy L. , Klemcke Harold G. , Mdaki Kennedy S. , Hudson Ian L. , Meledeo Michael A.
Published: February 2023

A solution of high concentration albumin has been used for temporal volume expansion when timely resuscitation was unavailable after hemorrhagic shock. However, during prolonged hemorrhagic shock, cell edema and interstitial dehydration can occur and impede the volume expansion effect of albumin. Polyethylene glycol-20K (PEG) can establish an osmotic gradient from swollen cells to capillary lumens and thus facilitate capillary fluid shift and volume expansion. We hypothesized that with similar osmolality, 7.5% PEG elicits more rapid and profound compensatory responses after hemorrhagic shock than 25% albumin. Rats were randomized into three groups (n = 8/group) based on treatment: saline (vehicle), PEG (7.5%), and albumin (25%). Trauma was induced in anesthetized rats with muscle injury and fibula fracture, followed by pressure-controlled hemorrhagic shock (MAP = 55 mm Hg) for 45 min. Animals then received an intravenous injection (0.3 mL/kg) of saline, PEG, or albumin. MAP, heart rate, blood gases, hematocrit, skeletal muscle capillary flow, renal blood flow, glomerular filtration rate, urinary flow, urinary sodium concentration, and mortality were monitored for another 2 hours. Polyethylene glycol-20K and albumin both improved MAP, renal and capillary blood flow, and renal oxygen delivery, and decreased hyperkalemia, hyperlactatemia, hematocrit, and mortality (saline: 100% PEG: 12.5%; albumin: 38%) over saline treatment. Compared with albumin, PEG had a more rapid decrease in hematocrit and more profound increases in MAP, diastolic pressure, renal blood flow, glomerular filtration rate, and urinary flow. These results suggest that PEG may be a better option than albumin for prolonged prehospital care of hemorrhagic shock.
Social Vulnerability Index is strongly associated with urban pediatric firearm violence: An analysis of five major US cities
Authors: Polcari Ann M. , Hoefer Lea E. , Callier Kylie M. , Zakrison Tanya L. , Rogers Selwyn O. , Henry Marion C.W. , Slidell Mark B. , Benjamin Andrew J.
Published: February 2023

BACKGROUND

Firearm-related injury in children is a public health crisis. The Social Vulnerability Index (SVI) identifies communities at risk for adverse effects due to natural or human-caused crises. We sought to determine if SVI was associated with pediatric firearm-related injury and thus could assist in prevention planning.

METHODS

The Centers for Disease Control and Prevention's 2018 SVI data were merged on census tract with 2015 to 2022 open-access shooting incident data in children 19 years or younger from Baltimore, Chicago, Los Angeles, New York City, and Philadelphia. Regression analyses were performed to uncover associations between firearm violence, SVI, SVI themes, and social factors at the census tract level.

RESULTS

Of 11,654 shooting incidents involving children, 52% occurred in just 6.7% of census tracts, which were on average in the highest quartile of SVI. A decile increase in SVI was associated with a 45% increase in pediatric firearm-related injury in all cities combined (incidence rate ratio, 1.45; 95% confidence interval, 1.41–1.49; p < 0.001). A similar relationship was found in each city: 30% in Baltimore, 51% in Chicago, 29% in Los Angeles, 37% in New York City, and 35% in Philadelphia (all p < 0.001). Socioeconomic status and household composition were SVI themes positively associated with shootings in children, as well as the social factors below poverty, lacking a high school diploma, civilian with a disability, single-parent household, minority, and no vehicle access. Living in areas with multi-unit structures, populations 17 years or younger, and speaking English less than well were negatively associated.

CONCLUSION

Geospatial disparities exist in pediatric firearm-related injury and are significantly associated with neighborhood vulnerability. We demonstrate a strong association between SVI and pediatric shooting incidents in multiple major US cities. Social Vulnerability Index can help identify social and structural factors, as well as geographic areas, to assist in developing meaningful and targeted intervention and prevention efforts.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Association of blood product ratios with early mortality in pediatric trauma resuscitation: A time-dependent analysis from the National Trauma Databank
Authors: Snyder Christopher W. , Neff Lucas P. , Chandler Nicole M. , Kerby Jeffrey D. , Josephson Cassandra D. , Russell Robert T.
Published: February 2023

BACKGROUND

Injured children with severe hemorrhage often receive blood product transfusions with ratios of plasma and platelets to packed red blood cells (PRBCs) approaching 1:1:1. Whether blood product ratios vary during pediatric resuscitation is unknown. This study (1) described precise timing of pediatric blood product administration, (2) characterized changes in blood product ratios over time, and (3) evaluated the association of blood products with early mortality while incorporating time-varying factors.

METHODS

Pediatric (younger than 18 years) trauma patients receiving high-volume transfusion (>40 mL/kg total products or >2 U PRBC or whole blood, during first 4 hours) were obtained from the 2017 to 2019 Trauma Quality Improvement Program database. The time of each individual product transfusion was recorded, along with demographics, injury details, and times of death. Patients were assigned to blood product groups at 15-minute intervals: high plasma/PRBC ratio (>1:1) with platelets, high plasma/PRBC ratio (>1:1) without platelets, low plasma/PRBC ratio (<1:1), PRBC only, and whole blood. Cox proportional hazards modeling for 24-hour mortality was performed, including blood product group as a time-varying variable and adjusting for relevant covariates.

RESULTS

Of 1,152 included patients (median age, 15 years; 32% penetrating, 28% severe traumatic brain injury [sTBI]), 18% died within 24 hours. During the resuscitation period, the number of patients in high-ratio groups increased over time, and patients switched blood product groups up to six times. There was no significant difference in mortality by blood product group. Among patients with sTBI, there was a strong trend toward lower mortality among high plasma/PRBC without platelets versus high plasma/PRBC with platelets (hazard ratio, 0.55; p = 0.07).

CONCLUSION

No significant association of high ratios or whole blood with mortality was seen when time-varying factors were incorporated. The impact of balanced resuscitation strategies, particularly platelet transfusion, may be greatest among patients with sTBI. Optimizing balanced resuscitation for children requires appropriately designed prospective studies.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Frequency, risk factors, and impacts on quality of life of the restless legs syndrome and side effects among antidepressant users in a tertiary hospital: an observational cross-sectional study
Authors: Cetin Erdem Hatice , Kara Huseyin , Ozcelik Ozgen , Donmez Levent , Eryilmaz Mehmet , Ozbey Gul
Published: February 2023

Restless leg syndrome (RLS) is a common but underestimated sensorimotor disorder that significantly affects the quality of life (QoL) which can be induced by antidepressants. This study aims to investigate the frequency and potential risk factors of RLS and side effects in selective serotonin reuptake inhibitors/serotonin and noradrenaline reuptake inhibitors (SSRI/SNRI) users. This cross-sectional study included 198 outpatients who received SSRI/SNRI for 4–8 weeks. Clinical evaluation was performed using the International Restless Leg Syndrome Study Group rating scale for RLS, Udvalg for Kliniske Undersøgelser side effects rating scale, and a short form 36 (SF-36) questionnaire for QoL. The frequency of RLS was 25%. RLS significantly increased with smoking and habituality. Also, habituality increased neurologic side effects reporting. The use of antipsychotics and calcium channel blockers decreased reporting of autonomic side effects. QoL decreased with RLS, psychiatric, neurologic, autonomic, and other side effects in different domains of SF-36. These findings suggested that SSRI/SNRI use could be associated with a higher risk of RLS, especially in smokers. QoL could be influenced negatively by RLS and all side effects. However, further prospective studies are needed to confirm these associations in large samples.
Prehospital triage of intracranial hemorrhage and anterior large vessel occlusion ischemic stroke: the value of the rapid arterial occlusion evalution
Authors: Dekker Luuk , Geraedts Victor J. , Hubert Jeroen , Duijndam Dion , Durieux Marcel D.J. , Janssens Loes , Moojen Wouter A. , van Zwet Erik W. , Wermer M.J.H. , Kruyt Nyika D. , van den Wijngaard Ido R.
Published: February 2023

Background

The Rapid Arterial oCclusion Evaluation (RACE) score can identify patients with anterior circulation large vessel occlusion (aLVO) ischemic stroke for transportation to a comprehensive stroke center for endovascular thrombectomy. However, patients with intracranial hemorrhage (ICH) may also benefit from direct transportation to a comprehensive stroke center for neurosurgical treatment. We aimed to assess if the RACE score can distinguish patients with ICH in addition to aLVO stroke from other suspected stroke patients.

Methods

We analyzed data from the Leiden Prehospital Stroke Study: a multicenter, prospective, observational cohort study in two Dutch ambulance regions. Ambulance paramedics documented prehospital observations in all patients ≥18 years with suspected stroke. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a positive RACE score (≥5 points) for a diagnosis of ICH or aLVO stroke, compared to patients with non-aLVO stroke, TIA, or stroke mimic. Additionally, we performed a multivariable logistic regression analysis and calculated adjusted odds ratios (aOR).

Results

We included 2004 stroke code patients, of whom 149 had an ICH, 153 an aLVO stroke, 687 a non-aLVO stroke, 262 a TIA and 753 a stroke mimic. Patients with ICH and aLVO stroke more often had a positive RACE score than other suspected stroke patients (respectively 46.2% and 58.0% vs. 6.4%, p<0.01). A positive RACE score had a sensitivity of 52.7%, specificity of 93.6%, PPV of 55.4% and NPV of 92.9% for a diagnosis of ICH or aLVO stroke. In multivariable analysis, a positive RACE score had the strongest association with ICH or aLVO stroke (aOR 10.11, 95% CI 6.84-14.93).

Conclusions and Relevance

Our study shows that the RACE score can also identify patients with ICH in addition to aLVO stroke. This emphasizes the potential of the RACE for improving prehospital triage and allocation of stroke patients.
Binding of SARS-CoV-2 non-structured protein 1 to 40S ribosome inhibits mRNA translation
Authors: Nguyen Hung , Nguyen Hoang Linh , Li Mai Suan
Published: February 2023

Experiments have shown that non-structural protein 1 (NSP1) of SARS-CoV-2 is a factor that restricts cellular gene expression and prevents mRNA translation in the ribosome 40S subunit. However, the molecular mechanism of this phenomenon remains unclear. To clarify this issue, all-atom steered molecular dynamics and coarse-grained alchemical simulations were used to compare the binding affinity of mRNA to 40S ribosome in the absence and presence of NSP1. We found that NSP1 binding to the 40S ribosome dramatically increases the binding affinity of mRNA, which, in agreement with experiment, suggests that NSP1 can stall mRNA translation. The mRNA translation has been found to be driven by electrostatic mRNA-40S ribosome interactions. Water molecules have been demonstrated to play an important role in stabilizing the mRNA-40S ribosome complex. The NSP1 residues that are critical in triggering a translation arrest have been identified.
Cell Surface Nucleocapsid Protein Expression: A Betacoronavirus Immunomodulatory Strategy
Authors: López-Muñoz Alberto Domingo , Santos Jefferson J.S. , Yewdell Jonathan W.
Published: February 2023

We recently reported that SARS-CoV-2 Nucleocapsid (N) protein is abundantly expressed on the surface of both infected and neighboring uninfected cells, where it enables activation of Fc receptor-bearing immune cells with anti-N antibodies (Abs) and inhibits leukocyte chemotaxis by binding chemokines (CHKs). Here, we extend these findings to N from the seasonal human coronavirus (HCoV)-OC43, which is also robustly expressed on the surface of infected and non-infected cells by binding heparan-sulfate/heparin (HS/H). HCoV-OC43 N binds with high affinity to the same set of 11 human CHKs as SARS-CoV-2 N, but also to a non-overlapping set of 6 cytokines (CKs). As with SARS-CoV-2 N, HCoV-OC43 N inhibits CXCL12β-mediated leukocyte migration in chemotaxis assays, as do all highly pathogenic and endemic HCoV N proteins. Together, our findings indicate that cell surface HCoV N plays important evolutionary conserved roles in manipulating host innate immunity and as a target for adaptive immunity.
Rapid resistance profiling of SARS-CoV-2 protease inhibitors
Authors: Moghadasi Seyed Arad , Biswas Rayhan G. , Harki Daniel A. , Harris Reuben S.
Published: February 2023

Resistance to nirmatrelvir (Paxlovid) has been shown by multiple groups and may already exist in clinical SARS-CoV-2 isolates. Here a panel of SARS-CoV-2 main protease (Mpro) variants and a robust cell-based assay are used to compare the resistance profiles of nirmatrelvir, ensitrelvir, and FB2001. The results reveal distinct resistance mechanisms (“fingerprints”) and indicate that these next-generation drugs have the potential to be effective against nirmatrelvir-resistant variants andvice versa.
Premarital sex and its association with child marriage among ever-married women: a study of national representative survey
Authors: Billah Md Arif , Khan Md. Mostaured Ali , Hanifi Syed Manzoor Ahmed , Islam M Mofizul , Khan Md. Nuruzzaman
Published: February 2023

Background

Sexual engagement before marriage (premarital sex) can influence child marriage; however, the evidence is scarce in low- and middle-income countries (LMICs), including Bangladesh. This study aimed to explore the association between premarital sex and child marriage among ever-married women aged 15-24 years.

Methods

We analysed data of ever-married women aged 15-24 years after extracting from the 2017/18 Bangladesh Demographic Health Survey (BDHS). Premarital sex (yes, no) was the primary exposure in this study, and child marriage was the outcome variable. Multilevel mixed-effect logistic regression models were used to determine the extent to which premarital sex influences the occurrence of child marriage.

Results

The prevalence of premarital sex and child marriage was 27% and 76.6%, respectively. Ever-married women who experienced child marriage had higher odds of reporting that they had engaged in premarital sex (aOR: 2.68; 95% CI: 2.20-3.26). The odds of premarital sex for women who experienced child marriage were higher in both urban (aOR: 2.67; 95% CI: 1.88-3.80) and rural areas (aOR: 2.69; 95% CI: 2.11-3.43). Child marriage was more common among women of relatively poor households who had premarital sex than those from other wealth quintiles.

Conclusion

Premarital sex significantly impacts girls’ child marriage in Bangladesh, and it varies greatly depending on the household’s socioeconomic status. Expanding existing school and community-based programmes aimed at reducing girls’ child marriage, abstinence from early premarital-sexual intercourse and context-specific multi-component interventions for at-risk young people may reduce these practices.
Factors associated with the utilisation of mosquito nets amongst rural adults: A cross-sectional study in East Nusa Tenggara Province Indonesia
Authors: Guntur Robertus Dole , Lobo Maria , Islam Fakir M Amirul
Published: February 2023

Backgrounds

The use of mosquito nets has shown a significant impact on the reduction to malaria burden; however, the utilisation of this kind prevention measures greatly depend on the community behaviour which is limited to be studied in Indonesia. This study explored the factors associated with the use of mosquito nets in the rural of East Nusa Tenggara Province (ENTP) Indonesia.

Methods

The community-based cross-sectional study to 1503 rural adults was carried out from October to December 2019. Data on the ownership and the utilisation of mosquito nets were collected using a standardized questionnaire. Logistic regression method was applied to determine the factors associated with the use of mosquito nets.

Results

The ownership (utilisation) of any mosquito nets, long-lasting insecticide treated nets (LLINs), and non-LLINs was 95.8% (82.3%), 71.6% (54.8%) and 42.7% (27.6%), respectively. The likelihood of the using of mosquito nets was significantly higher for adults in low malaria endemic settings (MES) than in high MES (adjusted odds ratio [AOR]: 10.1;95% CI, 6.17 to 16.5 for any mosquito nets, AOR: 11.1;95% CI, 7.32 to 16.7 for non-LLINs). The use of LLINs was significantly higher for adults living in Hills areas (AOR: 2.11;95%CI,1.37 to 3.25).

Conclusion

The coverage of the ownership nets was not followed by the utilisation of the nets in this province. To progress to malaria elimination in ENTP, the coverage and the utilisation of any mosquito nets should be high. Public health promotion to improve the awareness of the using of these nets should be prioritized, particularly for those living in high MES.