bluuebunny/crossref_metadata_2025 huggingface dataset:
Trauma Care in Low- and Middle-Income Countries
Authors: Shanthakumar Dhurka , Payne Anna , Leitch Trish , Alfa-Wali Maryam
Published: October 2021

Background Trauma-related injury causes higher mortality than a combination of prevalent infectious diseases. Mortality secondary to trauma is higher in low- and middle-income countries (LMICs) than high-income countries. This review outlines common issues, and potential solutions for those issues, identified in trauma care in LMICs that contribute to poorer outcomes.

Methods A literature search was performed on PubMed and Google Scholar using the search terms “trauma,” “injuries,” and “developing countries.” Articles conducted in a trauma setting in low-income countries (according to the World Bank classification) that discussed problems with management of trauma or consolidated treatment and educational solutions regarding trauma care were included.

Results Forty-five studies were included. The problem areas broadly identified with trauma care in LMICs were infrastructure, education, and operational measures. We provided some solutions to these areas including algorithm-driven patient management and use of technology that can be adopted in LMICs.

Conclusion Sustainable methods for the provision of trauma care are essential in LMICs. Improvements in infrastructure and education and training would produce a more robust health care system and likely a reduction in mortality in trauma-related injuries.
The Role of Information in Dental Traumatology in Patients during Developmental Age: A Cognitive Investigation
Authors: Ludovichetti Francesco Saverio , Signoriello Anna Giulia , Zuccon Andrea , Padovani Sharon , Mazzoleni Sergio
Published: October 2021

Objectives The gestation period involves a series of changes in all maternal organs and systems, due to hormonal fluctuations that also affect the oral cavity, leading to possible development of diseases such as gingivitis, oral pregnancy tumor, or periodontitis. Over the years, the positive correlation between poor oral health and adverse outcomes in pregnancy, such as fetal changes, low birth weight, preterm birth, or preeclampsia, has also been highlighted. The aim of this study is to analyze and understand the levels of knowledge and information of pregnant women about the possible repercussions that they may have on the oral cavity, caused by hormonal alterations.

Materials and Methods A questionnaire of 17 multiple choice questions was formulated and published online from 01/02/2020 to 31/08/2020, aimed at pregnant women and new mothers. The Google Forms platform was used to collect the data that were then statistically analyzed by creating crosstabs with multiple dependency variables.

Results The study cohort was represented by 1,191 women, whose responses first showed that about half were unaware of the predisposition to develop infections and periodontal problems during the gestation period. The same noticed bleeding and gum swelling during brushing and despite this, only 21% visited their dentist to resolve the situation. Furthermore, 88.2% of all women did not know that problems in the oral cavity can lead to adverse pregnancy outcomes.

Conclusion Primary prevention is essential and must be implemented with the collaboration of the various professional figures who follow the woman during gestation.
Sana Web Dialog 2021: Alter Alltag – neue Normalität?!
Authors: Salein Tobias , Heinze Johannes
Published: October 2021

Die Jahresveranstaltung von Sana Einkauf & Logistik (SEL) fokussierte sich auf dringliche Themen der Gesundheitsbranche und zukünftige Herausforderungen für Klinikeinkauf und -versorgung. Mit 25 Redebeiträgen in 120 Minuten setzte die Webkonferenz am 13. September eine Fülle von Impulsen.
Daten: Technische Voraussetzungen zur Sachkostensteuerung im Klinikeinkauf
Authors: Leuthold Jan , Marohn René
Published: October 2021

Für eine effektive Sachkostensteuerung bedarf es eine gute bis sehr gute Stammdatenqualität, wie in der letzten Ausgabe in dem Artikel „Wissensmosaik“ beschrieben. Nur wenn diese vorhanden ist, sind die aus den Daten abgeleiteten Kennzahlen und Aussagen belastbar und können zur Durchführung von Sachkostengesprächen mit dem Anwender sinnvoll genutzt werden.
Modernes Sachkostencontrolling: Digitale Produkte stehen in den Startlöchern
Authors: Pott Ariane
Published: October 2021

Im Bereich der Sachkosten schlummert in den meisten Kliniken ein großes Potenzial, um die Rentabilität zu erhöhen. Eine digitale Erfassung im OP kann der erste Schritt in das digitale Controlling sein.
Endotoxemia and cardiometabolic biomarkers in patients with acute myocardial infarction. Data from the RICO survey
Authors: Putot A , Masson D , Cottin Y , Gauthier T , Tribouillard L , Rerole A L , Maza M , Pais De Barros J P , Deckert V , Farnier M , Lagrost L , Zeller M ,   RICO survey
Published: October 2021

Background

The complex interplay between endotoxemia, inflammation and cardiometabolic diseases including acute myocardial infarction is poorly understood.

Aim

Our prospective study aimed to address the determinants of endotoxemia, including blood lipids and metabolic biomarkers, in patients admitted for an acute MI.

Methods

From the RICO survey, patients admitted to the coronary care unit of our University Hospital for type 1 acute MI were prospectively included between 2016 and 2018. Patients with prior coronary artery disease (CAD) or chronic kidney disease were excluded. Blood samples for biomarkers measurement were taken on admission. Endotoxemia was assessed by the LCMSMS measurement of circulating levels of LPS-derived 3-hydroxymyristate (3HM), a component of the lipid A moiety.

Results

Among the 245 patients included, mean age was 62±13 y, most were male (72%), almost half were hypertensive (43%), or current smokers (44%), 38% had hypercholesterolemia, or family history of CAD (31%), median (IQR) BMI was 27 (25–29) kg/m2 and 14% had diabetes. Median LDL-cholesterol was at 132 mg/dL, HDL-cholesterol at 47 mg/dL, total cholesterol at 209 mg/dL and triglycerides (TG) at 116 mg/dL. Median (IQR) 3HM levels were at 106 (83–131) pmol/L. Among biomarkers, TG levels were the most strongly correlated with LPS levels (r=0.201, p=0.002), beyond HbA1c (r=0.197, p=0.002), BMI (r=0.192, p=0.003), cholesterol (r=0.191, p=0.003), blood glucose (r=0.174, p=0.006) and age (r=0.173, p=0.007). Inflammatory biomarkers and cytokines (CRP, IL6, IL8, TNF α) did not significantly relate to 3HM levels. When compared with patients without diabetes, patients with diabetes had ≈40% higher levels of 3HM (140 vs 103 pmol/L, p<0.001). By multivariate regression linear analysis, TG (β(95% CI)=0.288 (7.757–20.357), p<0.001) remained an independent determinant of 3HM levels, beyond age (β(95% CI)=0.184 (0.274–1.374), p=0.003), and HbA1c (β(95% CI)=0.157 (1.764–15.390), p=0.014).

Conclusions

In a former analysis of our prospective study in patients with acute MI, endotoxemia levels related mainly to chronic metabolic disorders including diabetes and hypercholesterolemia. The underlying mechanisms for the LPS-associated TG elevations and its clinical significance at the acute phase of MI remains to be explored.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche comté
A scaling law of multilevel evolution: how the balance between within- and among-collective evolution is determined
Authors: Takeuchi Nobuto , Mitarai Namiko , Kaneko Kunihiko
Published: October 2021

Numerous living systems are hierarchically organized, whereby replicating components are grouped into reproducing collectives—e.g., organelles are grouped into cells, and cells are grouped into multicellular organisms. In such systems, evolution can operate at two levels: evolution among collectives, which tends to promote selfless cooperation among components within collectives (called altruism), and evolution within collectives, which tends to promote cheating among components within collectives. The balance between within- and among-collective evolution thus exerts profound impacts on the fitness of these systems. Here, we investigate how this balance depends on the size of a collective (denoted by N) and the mutation rate of components (m) through mathematical analyses and computer simulations of multiple population genetics models. We first confirm a previous result that increasing N or m accelerates within-collective evolution relative to among-collective evolution, thus promoting the evolution of cheating. Moreover, we show that when within- and among-collective evolution exactly balance each other out, the following scaling relation generally holds: Nmα is a constant, where scaling exponent α depends on multiple parameters, such as the strength of selection and whether altruism is a binary or quantitative trait. This relation indicates that although N and m have quantitatively distinct impacts on the balance between within- and among-collective evolution, their impacts become identical if m is scaled with a proper exponent. Our results thus provide a novel insight into conditions under which cheating or altruism evolves in hierarchically organized replicating systems.
Hypertrophic Granulation Wounds Treated With Silver Nitrate Sticks or With Topical Steroid: Rate of Wound Closure
Authors: Linneman Paul K , Litt Jeffrey
Published: October 2021

Hypertrophic granulation (HG) is abnormal granulation tissue raised above the level of surrounding intact skin and is thought to delay wound healing. Effective treatment to eliminate HG could speed healing, but this is not well studied. Two common treatments are chemical cautery with silver nitrate, and the use of topical steroids. In a Midwestern burn and wound clinic, both of these treatments are employed. A quality improvement project compared wound size reduction for HG wounds undergoing the two treatment modalities. Retrospective chart review identified HG wounds treated during a 1-year period, and compared wound size prior to and after 1 month of treatment (length, width, and surface area). Results were presented to the clinic staff, and 1 year later the quality assurance project was repeated. The initial audit found data on 18 patients treated with silver nitrate cautery, and 16 patients treated with 1% hydrocortisone cream. Median length and width were decreased by 5 mm with silver nitrate cautery treatment, and by 14 mm with 1% hydrocortisone treatment (P < .05). The repeat audit 1 year later found 10 patients treated with silver nitrate, and 38 treated with hydrocortisone. Median length and width decreased by 0 and 2 mm respectively for silver nitrate cautery treatment, and 15 and 10 mm for 1% hydrocortisone treatment (P < .05). In conclusion, this uncontrolled review suggests faster healing in HG wounds treated with 1% hydrocortisone compared with those treated with silver nitrate cautery. Confirmation with controlled and randomized studies is warranted.
Role of microhabitat and temporal activity in facilitating coexistence of endemic carnivores on the California Channel Islands
Authors: Bolas Ellen C , Sollmann Rahel , Crooks Kevin R , Boydston Erin E , Shaskey Laura , Boser Christina L , Dillon Adam , Van Vuren Dirk H
Published: October 2021

Most extinctions worldwide have occurred on islands, primarily due to interactions with exotic species, but rarely due to interactions among endemic species. This potential exists on two of the California Channel Islands, Santa Cruz and Santa Rosa, as endemic island spotted skunks (Spilogale gracilis amphiala) appear to have rapidly declined to rarity, possibly due to interference competition with endemic island foxes (Urocyon littoralis). Niche partitioning is expected in response to interference competition; hence, it is surprising that skunks and foxes show extensive overlap in macrohabitat use and circadian activity. However, the role of microhabitat associations and fine-scale temporal activity in facilitating coexistence of the two species has not been explored. We evaluated microhabitat associations of island spotted skunks and island foxes across both islands using data from live traps and wildlife cameras collected during 2015–2017, and we analyzed fine-scale temporal activity using camera data from 2016 and 2017. On both islands, skunks had a positive response to ground-level cover provided by rugged topography or woody vegetation such as shrubs or trees, whereas foxes had a weak or negative response, suggesting partitioning of these microhabitat characteristics. Additionally, on both islands the peak in timing of skunk activity offset the peak for foxes, which implies that skunks use fine-scale adjustments in activity to avoid foxes. Past grazing by exotic herbivores likely reduced habitat refuges for skunks; however, as vegetation on both islands recovers, regrowth of shrubs and trees may provide cover that will improve prospects for coexistence of island spotted skunks and island foxes.
Ambulatory Fluoroquinolone Use in the United States, 2015–2019
Authors: Umarje Siddhi Pramod , Alexander Caleb G , Cohen Andrew J
Published: October 2021

Background

Frequently used fluoroquinolones have been subject to increasing safety concerns and regulatory alerts. This study characterized ambulatory fluoroquinolone utilization in the United States and evaluated the impact of 2016 Food and Drug Administration (FDA) safety advisories on its use.

Methods

We used IQVIA’s National Disease and Therapeutic Index to quantify adult outpatient fluoroquinolone use (“treatment visits”). Descriptive statistics and segmented regression were used to report trends and quantify the varied use before and after FDA’s 2016 alerts.

Results

Between 2015 to 2019, fluoroquinolone use decreased by 26.7% (18.7 million treatment visits in 2015 to 13.7 million treatment visits in 2019). Annual use declined by 44%, 24%, and 24% for respiratory, urogenital, and gastrointestinal conditions, respectively; and by 66% among providers ≤44 years old vs negligible decline among those ≥65 years old. Before 2016 FDA advisories, there were approximately 4.8 million fluoroquinolone treatment visits/quarter, which had a statistically significant immediate drop by 641035 visits (95% confidence interval [CI], –937368 to –344702; P=.000) after FDA’s 2016 advisories. A statistically significant difference of approximately 45000 visits/quarter (95% CI, –85956 to –3122; P=.036) was observed after the advisories.

Conclusions

Large reductions in ambulatory fluoroquinolone use in the United States have coincided with increasing evidence of safety concerns and FDA advisories. However, fluoroquinolone use varies significantly based on patient and provider characteristics, suggesting heterogeneous effects of emerging risks on clinical practice.
Ancient Melt-Depletion in Fresh to Strongly Serpentinized Tonga Trench Peridotites
Authors: Day James M D , Brown Diana B
Published: October 2021

Peridotites from the Tonga Trench are some of the deepest-derived and freshest ever obtained from the seafloor. This study reports new bulk-rock major-, trace-, highly siderophile-element (HSE) abundance and 187Os/188Os data, as well as major- and trace-element abundances of mineral phases for NOVA88D dredge peridotites. The samples are harzburgites that experienced varying degrees of serpentinization, recorded in their loss on ignition (LOI) values, from zero to 16.7%. Degree of serpentinization in samples is correlated with Na, B, K, Sr, Ca, Rb and U, and weakly correlated with W, Fe, Pb, Cs and Li abundances, but is uncorrelated with other lithophile elements, most especially the rare earth elements (REE). Serpentinization had no systematic effect on the HSE abundances or 187Os/188Os compositions in the harzburgites. NOVA88D harzburgites record >18% melt depletion which has resulted in heterogenous distribution of the HSE within the rocks, likely due to retention of these elements within sub-micron sized alloy or sulphide phases. Time of rhenium depletion (TRD) ages, recorded by Os isotopes, average ~ 0.7 ± 0.4 Ga and can be as ancient as 1.5 Ga. Some harzburgite compositions are consistent with minor melt infiltration processes modifying incompatible trace element compositions and Re abundances, with a possible melt infiltration event at ~120 Ma based on 187Re-188Os, prior to the inception of subduction at the Tonga Trench at ~52 Ma. Evidence for ancient melt depletion, combined with limited melt processing since inception of subduction suggests that NOVA88D harzburgites represent melt residues incorporated into the Tonga arc, rather than their geochemical signatures being produced beneath the recent arc. Estimates of fO2 (~ − 0.4 ± 0.4 ΔFMQ) and olivine-spinel equilibration temperatures for the Tonga Trench samples (830 ± 120 ̊C) are similar to abyssal peridotites and some Izu-Mariana-Bonin peridotites. These values are unlikely to relate directly to recorded degrees of melt depletion and melt depletion ages in the rocks. Refractory residues from prior melt depletion events are probably common in the convecting mantle, and those with high degrees of melt depletion (>18%) and relatively ancient melt depletion ages (<2 Ga) are likely to have been formed during prior melting processes rather than melting processes within their current tectonic setting. These refractory peridotites can be incorporated into a range of tectonic settings, including into mid-ocean ridges, succeeding arcs, or within the continental lithospheric mantle, where they may play a limited role in melt generation processes.
The response of a pediatric ED to COVID-19
Authors: Elwell Sean , Alfonsi Laura , Lietzke Lisa , Thomas James
Published: October 2021

At the beginning of the pandemic, little was known about the effect of COVID-19 on children, urging pediatric health care systems to rapidly, efficiently, and safely address new challenges. This article describes structural, procedural, and functional changes developed in a pediatric ED to respond to the COVID-19 pandemic. The discussion also includes case studies to illustrate the changes made.
Simulation Versus Interactive Mobile Learning for Teaching Extracorporeal Membrane Oxygenation to Clinicians: A Randomized Trial
Authors: Gannon Whitney D. , Stokes John W. , Pugh Meredith E. , Bacchetta Matthew , Benson Clayne , Casey Jonathan D. , Craig Lynne , Semler Matthew W. , Shah Ashish S. , Troutt Ashley , Rice Todd W.
Published: October 2021

OBJECTIVES:

Extracorporeal membrane oxygenation has become integral to critical care. Data informing optimal extracorporeal membrane oxygenation education modalities are lacking. We aimed to compare the effect of high-fidelity simulation versus interactive mobile learning on extracorporeal membrane oxygenation knowledge acquisition and retention among clinicians.

DESIGN:

Observer-blinded, randomized controlled trial.

SETTING:

A single academic medical center.

SUBJECTS:

Forty-four critical care clinicians with limited extracorporeal membrane oxygenation experience.

INTERVENTIONS:

Participants were randomized to receive: 1) simulation: three high-fidelity training scenarios, 2) QuizTime: 15 total multiple-choice questions delivered over 3 weeks via mobile device, or 3) experiential: no formal training. Participants completed a survey, written knowledge examination, and simulation assessment prior to randomization, immediately following the intervention, and 4 month postintervention.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was knowledge about extracorporeal membrane oxygenation assessed by score on the immediate postintervention written examination. Secondary outcomes included performance in extracorporeal membrane oxygenation simulation postintervention and 4 months later assessed by a rater blinded to group assignment. Clinicians randomized to simulation (n = 15), QuizTime (n = 14), and experiential (n = 15) had similar baseline characteristics. Adjusting for baseline knowledge, postintervention examination scores were higher in the simulation group (90.0%; interquartile range, 85.0–90.0%) than the QuizTime group (70.0%; interquartile range, 65.0–80.0%; p = 0.0003) and the experiential group (75.0%; interquartile range, 65.0–80.0%; p = 0.001). Scores did not differ between the groups at 4 months (p > 0.05 in all analyses). In postintervention extracorporeal membrane oxygenation simulations, the simulation group demonstrated shorter time to critical action compared with QuizTime (80.0 s [interquartile range, 54.0–111.0 s] vs 300.0 s [interquartile range 85.0–300.0 s]; p = 0.02) and compared with both QuizTime (45.0 s [interquartile range, 34.0–92.5 s] vs 255.5 s [interquartile range, 102.0–300.0 s]; p = 0.008) and experiential (300.0 s [interquartile range, 58.0–300.0 s]; p = 0.009) at 4 months.

CONCLUSIONS:

Simulation was superior to QuizTime and experiential learning with regard to extracorporeal membrane oxygenation knowledge acquisition. Further studies are needed to ascertain the effect of these interventions on knowledge retention, clinical performance, and patient outcomes.
Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis
Authors: Felfeli Tina , Georgakopoulos Jorge R. , Jo Christine E. , Mimouni Michael , Piguet Vincent , Drucker Aaron M. , Yeung Jensen , Chan Clara C.
Published: October 2021

Purpose:

Dupilumab-induced ocular surface disease (DIOSD) is a common reaction among patients treated for atopic dermatitis. This study aimed to identify the clinical characteristics, associated risk factors, treatment strategies, and long-term outcomes of DIOSD.

Methods:

We conducted a multicenter retrospective cohort study of consecutive adult outpatients treated with dupilumab for moderate-to-severe atopic dermatitis from 2017 through 2021 at 2 tertiary care centers. We used stepwise multivariable logistic regression to assess the association between patient characteristics and development of DIOSD.

Results:

Among 210 patients treated with dupilumab, 37% (n = 78) developed DIOSD over the 52-week follow-up period. Vision-threatening complications including corneal scarring and cicatricial ectropion were noted in 1% (n = 3) of patients. Clinical features were blepharoconjunctivitis (68%, n = 53), burning/stinging/dryness (14%, n = 29), epiphora (13%, n = 10), pruritus (13%, n = 10), blurred vision (3%, n = 2), and photophobia (1%, n = 1). DIOSD was associated with a history of asthma (odds ratio: 2.94, 95% confidence interval: 1.26–6.87, P = 0.01) and a family history of atopic dermatitis (odds ratio: 2.58, 95% confidence interval: 1.08–6.17, P = 0.03). Interventions were initiated for 63% of patients with DIOSD, with artificial tears (56%) and corticosteroid drops (29%) most commonly used. Dupilumab was discontinued because of DIOSD in 4% of patients.

Conclusions:

DIOSD is a common adverse event that is usually mild but may lead to treatment interruption and vision-threatening complications. A personal history of asthma and family history of atopic dermatitis may be associated with a higher risk of developing DIOSD.
Clinical Utility of COVID-19 Real Time-Polymerase Chain Reaction Testing of Ocular Tissues of Non–COVID-19 Cornea Donors Deemed Suitable for Corneal Retrieval and Transplantation
Authors: Chaurasia Sunita , Rudraprasad Dhanwini , Senagari Jalandhar Reddy , Reddy Sunitha Linga , Kandhibanda Srinivas , Mohamed Ashik , Basu Sayan , Garg Prashant , Joseph Joveeta
Published: October 2021

Purpose:

The purpose of this study was to evaluate the prevalence of SARS-CoV-2 in human postmortem ocular tissues of asymptomatic donors and its implications on our eye banking protocols.

Methods:

The expression of SARS-CoV-2 RNA was assessed by reverse transcription–polymerase chain reaction in corneal rims and conjunctival tissues from 100 donors who were found suitable for transplantation as per the donor screening guidelines of the Global Alliance of Eye Bank Associations. The donor's clinical history and cause of death were assessed for secondary analysis.

Results:

Of 200 ocular tissues (100 corneal and 100 conjunctival) from the same 1 eye of 100 surgical-intended donors, between September 2020 and April 2021, the overall positivity rate for SARS-CoV-2 was ∼1% (2/200). Both the ocular samples that tested positive were conjunctival biopsies (2/100, 2%), whereas corneal samples were negative (0/100, 0%) in both donors. The causes of donor death were trauma in 51 donors, suicide in 33, cardiac arrest in 7, electric shock in 5, metabolic cause in 2, malignancy in 1, and snake bite in 1. None of the donors had a medical history suggestive of COVID infection or possible contact. None of the recipients from the donors were reported to have any systemic adverse event after keratoplasty until the follow-up of 6 weeks.

Conclusions:

The overall prevalence of SARS-CoV-2 was 1% (2% for conjunctival and 0% for corneal samples, P value = 0.5) in the donors who were found suitable for cornea recovery and transplantation. The findings of exceptionally low positive rates in our samples validate the criticality of history-based donor screening and do not support the necessity of postmortem PCR testing as a criterion for procurement and subsequent use for corneal transplantation.
Diabetes Mellitus and Keratoconus: A Systematic Review and Meta-Analysis
Authors: Dong Xing-Xuan , Liu Kai-Fan , Zhou Miao , Liang Gang , Pan Chen-Wei
Published: October 2021

Purpose:

Although previous studies have assessed the relationship between diabetes and keratoconus, the findings were controversial and warranted further clarifications. The objective of this study was to investigate the association between diabetes and keratoconus by conducting a systematic review and meta-analysis.

Methods:

A comprehensive literature search was performed to identify eligible studies reporting the association of diabetes with keratoconus from their inception to April 2021 through PubMed, Embase, and Web of Science. The quality of included studies was assessed using the Newcastle–Ottawa scale. Combined odds ratios (ORs) and 95% confidence intervals were calculated using a random-effects model.

Results:

In all, 8 case–control studies and 3 cohort studies reporting the association between diabetes and keratoconus were included in the meta-analysis. Diabetes was not associated with keratoconus in the overall analysis (combined OR = 0.85, 95% confidence interval: 0.66–1.10). The associations were found to be nonsignificant in subgroup analysis when stratified by study quality, design, source, types, and population. No publication bias was detected from either the Egger test (P = 0.46) or Begg test (P = 0.16). Sensitivity analysis revealed that differences between groups were not statistically significant.

Conclusions:

This meta-analysis indicates that current literature does not support a significant association between diabetes and keratoconus. Further studies with more definite control for confounders and well-designed cohorts or interventions are warranted.
Therapeutic Corneal Transplantation in Acanthamoeba Keratitis: Penetrating Versus Lamellar Keratoplasty
Authors: Di Zazzo Antonio , Varacalli Giuseppe , De Gregorio Chiara , Coassin Marco , Bonini Stefano
Published: October 2021

Purpose:

The purpose of this article was to compare clinical outcomes between therapeutic penetrating keratoplasty (TPK), therapeutic deep anterior lamellar keratoplasty (TDALK), and optical penetrating keratoplasty (OPK) in Acanthamoeba keratitis.

Methods:

A literature search was conducted in online libraries from 1980 to 2021. The primary end points were best-corrected visual acuity (VA), graft survival, and infection recurrence. In addition, we enrolled 35 consecutive patients with AK from our practice evaluating best-corrected VA and high-order aberrations.

Results:

A total of 359 AK eyes from 33 published studies were retrieved from 175 publications screened. One hundred sixty-five eyes (73%) that underwent TPK and 39 eyes (84%) treated with TDALK had a clear graft at the last follow-up visit. Only the patients treated with OPK had 82 clear grafts (94%) during the follow-up period. Forty-seven (21%) of TPK patients reached VA ≥20/30, compared with 11 (25%) of TDALK patients and 35 (40%) of OPK patients. Acanthamoeba infection recurrence occurred in 38 eyes (16.8%) that underwent TPK, 9 (19%) that underwent TDALK, and 8 (9.5%) that underwent OPK. In our series, best-corrected visual acuity in nonsurgically treated patients was 1 ± 0.50 logMAR compared with 0 logMAR of surgically treated patients. High-order aberrations were significantly lower in surgically treated eyes after AK resolution, particularly in TDALK when compared with TPK patients. Best-corrected visual acuity was better in TDALK patients compared with TPK patients.

Conclusions:

After AK resolution by 6 to 12 months of medical treatment, OPK seems to be the best surgical choice in patients with AK. If AK could not be eradicated by medical therapy, TDALK may be chosen in the early disease stage and TPK in later stages.
Late-Onset Nontuberculous Mycobacterial Keratitis After Small Incision Lenticule Extraction
Authors: Wan Kelvin H. , Lam Julia T. W. , Lam Nai Man , Chow Vanissa W. S.
Published: October 2021

Purpose:

The purpose of this article was to report a case of unilateral late-onset nontuberculous mycobacterial keratitis after small incision lenticule extraction (SMILE).

Methods:

This was a case report.

Results:

A 27-year-old woman presented with Mycobacterium chelonae keratitis 3 weeks after uncomplicated SMILE with a solitary interface infiltrate. The keratitis worsened after an initial response to topical fortified and interface antibiotic irrigation. Despite repeated interface irrigation and topical and oral antibiotics, progressive, diffuse stromal infiltrates followed by melting of the cap ensued over the next 6 weeks. Cap amputation and intrastromal antibiotic injection followed by prolonged topical and oral antibiotics usage for the following 5 weeks led to infiltrate resolution and re-epithelization of the residual stromal bed. All medications were tapered off over 6 months after initial presentation without recurrence, but anterior stromal scarring and corneal neovascularization persisted.

Conclusions:

Cap amputation and intrastromal antibiotic injection for intractable post-SMILE keratitis can prevent the need for therapeutic keratoplasty.
Acute Corneal Transplant Rejection After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccination
Authors: Yu Suyeon , Ritterband David C. , Mehta Isha
Published: October 2021

Purpose:

The purpose of this article was to report a case of full-thickness corneal transplant rejection 3 days after immunization with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Moderna mRNA-1273 vaccine.

Methods:

Case Report.

Results:

A 51-year-old man with a history of keratoconus and penetrating keratoplasty underwent repeat penetrating keratoplasty for graft failure. The patient had an uncomplicated intraoperative and postoperative course with improved vision and a healthy graft. The patient received the SARS-CoV-2 Moderna vaccine on postoperative week 3, and within 3 days, the patient began developing eye pain, photophobia, and blurred vision. The patient was found to have graft rejection with corneal edema and endothelial keratic precipitates. The rejection did not improve despite a trial of increased topical steroids and ultimately evolved into graft failure.

Conclusions:

To the best of our knowledge, this case of full-thickness graft rejection after the Moderna SARS-CoV-2 mRNA vaccination is the first to be reported worldwide. The temporal relationship between vaccination and subsequent rejection is highly suggestive of causation due to the short interval (3 days) between vaccination and rejection and the lack of other inciting factors in an otherwise healthy graft. Patients with corneal transplants who plan to take the COVID-19 vaccinations should be counseled on symptoms and closely monitored, and an individualized plan should be made in discussion with the ophthalmologist.
Importance of Corneal Angiography in Subclinical Limbitis in a Case of Atopic Keratoconjunctivitis
Authors: Romano Davide , Coco Giulia , Borgia Alfredo , Kaye Stephen B. , Romano Vito
Published: October 2021

Purpose:

The aim of this study was to report corneal angiography features in subclinical limbitis in a patient with atopic keratoconjunctivitis.

Methods:

This is a case report.

Results:

A 22-year-old woman with a medical history of atopic keratoconjunctivitis was referred for bilateral corneal neovascularization with scarring. On examination, no signs of active disease were noticed at the slit lamp. Ocular surface angiography detected active corneal limbitis, showing as limbal leakage at fluorescein angiography in the early phase and leakage after indocyanine green angiography in the late phase. The patient was treated with topical corticosteroid. At follow-up, the fluorescein angiography and indocyanine green angiography no longer showed limbal leakage, whereas the slit lamp examination was unchanged.

Conclusions:

Active allergic corneal limbitis may present as subclinical inflammation, with no signs of activity at the slit lamp examination. Therefore, its diagnosis can be challenging without the use of corneal angiography.
Severe Infant Meningoencephalitis Caused by Salmonella Apeyeme: A Case Report
Authors: Srisingh Klaita , Srijuntongsiri Sarunya , Apiraknapanon Yasinee , Chuenkeson Tanatporn , Chinnarakbumrung Raksit , Phuaksaman Chutima
Published: October 2021

Salmonella enterica serovar Apeyeme is a rare pathogen that primarily affects poultry. However, there are limited data about this infection in humans. In this case, a 7-month-old infant presented with high-grade fever without diarrhea for 12 hours prior to admission. Upon admission, he developed seizures and was referred for further intervention. He was diagnosed with meningoencephalitis with complications of subdural effusion, empyema, and abscesses. Salmonella Apeyeme was found in cerebrospinal fluid culture, but no growth was detected in either blood or stool cultures. He was given meropenem, vancomycin, and ciprofloxacin, but later developed disseminated intravascular coagulation. His clinical condition deteriorated over time, and he died 18 days after admission. To conclude, Salmonella Apeyeme infection should be considered if a patient is diagnosed with meningoencephalitis and has a history of poultry exposure.
A protective effect of morning radiotherapy on acute skin toxicity in patients with breast cancer
Authors: Fuzissaki Marceila A. , Paiva Carlos E. , Oliveira Marco A. , Maia Marcelo A. , Canto Paula P.L. , Maia Yara C.P.
Published: October 2021

The focus of this prospective cohort study was to evaluate the risk factors of severe acute skin toxicity (grade ≥2) in 100 patients with breast cancer (BC) during radiotherapy (RT).

The patients were evaluated weekly during RT and 3 months after treatment. The endpoint included the occurrence of skin toxicity grade ≥2, according to Radiation Therapy Oncology Group (RTOG). Survival analysis was conducted by univariate and multivariate Cox regression analysis.

In the multivariate analysis, RT in the afternoon (0–3 pm) (hazard ratios [HR] = 1.566, P = .042) was significantly associated with the early occurrence of skin toxicity, indicating a potential effect of chronotherapy related to this adverse event. In the univariate and multivariate analysis, skin phototype moderate brown (HR = 1.586, P = .042; HR = 1.706, P = .022, respectively) and dark brown or black (HR = 4.517, P < .001; HR = 5.336, P < 0.001, respectively) was significantly associated with the skin toxicity. Tangential field separation >21 cm (HR = 2.550, P = .009, HR = 2.923, P = .003), in women that were submitted to conservative surgery indicates indirectly that large breast size was also significantly associated with skin toxicity.

Women with large breasts and dark brown or black skin should be followed more carefully during RT, which should be undergone in the morning, especially when submitted to conventional RT techniques, common in developing countries.
Ocular chemical burn associated with gel type alcohol-based hand sanitizer
Authors: Lee Jaekyoung , Jun Jong Hwa
Published: October 2021

Introduction:

Alcohol-based hand sanitizers (ABHS) are widely used for hand hygiene due to the coronavirus disease pandemic. However, risk awareness regarding its adverse effects is lacking. We aim to report a case of ocular chemical burn that showed severe clinical presentation associated with ABHS.

Patient concerns:

A 5-year-old girl presented with severe left eye pain after 62% gel-type ABHS splashed into her eye.

Diagnosis:

On slit lamp examination, a near total corneal and conjunctival epithelial defect with limbal pale on the lower half of the cornea was noted. Severe ocular burn by ABHS was prominent with suspected limbal stem cell damage.

Interventions:

She was hospitalized and was prescribed topical medications including antibiotics, steroid eye drops with preservative-free artificial tears, and oral nonsteroidal anti-inflammatory drugs.

Outcomes:

Despite intensive medical treatments, the corneal and conjunctival epithelial defects showed no improvement up to the 4th hospital day. After additional instillation of autoserum eye drops to promote epithelial healing, the corneal epithelium barely recovered from the temporal limbus. On the third week of admission, the epithelial defect was completely resolved without corneal opacity, although with minimal symblepharon in the lower fornix.

Conclusions:

Gel-type ABHS can cause severe form of ocular chemical burn such as delayed ocular surface healing. In clinical setting, immediate and thorough rinsing of alcohol-based gel and early intensive treatment are crucial.
Association between the transtheoretical model approach and sustained intradialytic pedaling exercise
Authors: Murakami Minoru , Aoki Takuya , Sugiyama Yoshifumi , Takeuchi Minori , Yui Tomoko , Koyama Miyuki , Ichikawa Yuhei , Yanagisawa Kazuki , Furuhata Shunichi , Ikezoe Masaya , Ota Tadashi , Matsushima Masato
Published: October 2021

The transtheoretical model (TTM) is a promising approach to the promotion of behavior change, but it remains to be established whether there is an association between the TTM approach and intradialytic exercise among patients on hemodialysis (HD) with low motivation to exercise in a real-world setting.

This retrospective cohort study, conducted in a regional hospital in Japan, included adult outpatients receiving HD 3 times per week who had never participated in intradialytic pedaling exercise despite the encouragement of the HD personnel. Patients were divided into 2 groups according to HD weekday. Patients undergoing HD on Tuesday, Thursday, and Saturday were encouraged by the HD unit team to exercise during HD based on the TTM (exposure group) and those receiving HD on Monday, Wednesday, and Friday were encouraged to exercise as usual (control group). The primary outcome was sustained intradialytic exercise using a leg ergometer, defined as a total of 72 sessions of 30-minute pedaling exercise (duration of at least 6 months).

Overall, 85 patients were included in the analysis (mean age: 67.1 ± 11.9 years, 22% female). Of 33 patients in the exposure group, 10 (30%) maintained intradialytic exercise, compared with 2 of 52 patients (4%) in the control group. Log-binomial regression models with stabilized inverse probability of treatment weighting showed a significant association between the TTM approach and sustained intradialytic exercise (adjusted risk ratio 9.23 [95% confidence interval 2.13–40.00]). There were no exercise-related cardiovascular events.

Among patients with low motivation to exercise during HD, use of the TTM approach in clinical practice was associated with sustained intradialytic exercise compared with usual care.
Evaluation of efficacy and safety of vertebroplasty in the treatment of osteoporotic vertebral compression fracture
Authors: Li Jie , Huang Xin , Zhong Guo
Published: October 2021

Background:

Osteoporosis is a common condition that affects bones. Osteoporotic vertebral compression fracture (OVCF) is a highly prevalent complication related to osteoporosis. Each year, OVCF affects nearly 700,000 individuals. Nowadays, there are many surgical methods to treat OVCF, and each has distinct advantages. Among them, the efficacy and safeness of vertebroplasty are yet to be established. The present article will systematically ascertain the effectiveness and security of using vertebroplasty to treat OVCF.

Methods:

All articles related to the research topic published from establishment to July 2021 will be retrieved from the following e-databases Medline, Cochrane library, PubMed database, China National of Knowledge Infrastructure, Web of Science, Embase database, and WanFang database. The collected articles will be related to the use of vertebroplasty to treat OVCF. All included articles will adhere to the standards, and will be screened by 2 independent authors. After extracting the data in the article, Review Manager 5.3 software will be used for data analysis.

Results:

This study will assess the efficacy and safety of using vertebroplasty to treat OVCF by pooling the results of each study.

Conclusion:

Our findings will present strong evidence to help determine whether vertebroplasty therapy is efficient and safe for OVCF patients.
End stage liver disease etiology & transplantation referral outcomes of major ethnic groups in British Columbia, Canada
Authors: Chahal Daljeet , Marquez Vladimir , Hussaini Trana , Kim Peter , Chung Stephen W. , Segedi Maja , Chartier-Plante Stephanie , Scudamore Charles H. , Erb Siegfried R. , Salh Baljinder , Yoshida Eric M.
Published: October 2021

Liver disease etiology and transplantation outcomes may vary by ethnicity. We aimed to determine if disparities exist in our province.

We reviewed the provincial database for liver transplant referrals. We stratified cohorts by ethnicity and analyzed disease etiology and outcomes.

Four thousand nine hundred sixteen referrals included 220 South Asians, 413 Asians, 235 First Nations (Indigenous), and 2725 Caucasians. Predominant etiologies by ethnicity included alcohol (27.4%) and primary sclerosing cholangitis (PSC) (8.8%) in South Asians, hepatitis B (45.5%) and malignancy (13.9%) in Asians, primary biliary cholangitis (PBC) (33.2%) and autoimmune hepatitis (AIH) (10.8%) in First Nations, and hepatitis C (35.9%) in Caucasians. First Nations had lowest rate of transplantation (30.6%, P = .01) and highest rate of waitlist death (10.6%, P = .03). Median time from referral to transplantation (268 days) did not differ between ethnicities (P = .47). Likelihood of transplantation increased with lower body mass index (BMI) (hazard ratio [HR] 0.99, P = .03), higher model for end stage liver disease (MELD) (HR 1.02, P < .01), or fulminant liver failure (HR 9.47, P < .01). Median time from referral to ineligibility status was 170 days, and shorter time was associated with increased MELD (HR 1.01, P < .01), increased age (HR 1.01, P < .01), fulminant liver failure (HR 2.56, P < .01) or South Asian ethnicity (HR 2.54, P < .01). Competing risks analysis revealed no differences in time to transplant (P = .66) or time to ineligibility (P = .91) but confirmed increased waitlist death for First Nations (P = .04).

We have noted emerging trends such as alcohol related liver disease and PSC in South Asians. First Nations have increased autoimmune liver disease, lower transplantation rates and higher waitlist deaths. These data have significance for designing ethnicity specific interventions.
The incidence of psoriasis among smokers and/or former smokers inflammatory bowel diseases patients treated with tumor necrosis factor antagonist
Authors: Yang Meiqi , Liu Weixin , Deng Qiuping , Liang Zeng , Wang Qin
Published: October 2021

Background:

Infliximab (IFX) and adalimumab (ADA) refer to the classic drugs to treat moderate-severe inflammatory bowel disease (IBD), which have been proven to be effective to control IBD. However, the side effects exerted by IFX and ADA should be monitored in therapies, especially the paradoxical reaction of the skin system (e.g., psoriasis). Psoriasis is recognized as the most common skin lesion, capable of significantly affecting the quality of patients’ life.

Methods:

This study searched literatures published in English language with the qualifications on PubMed, Embase, Web of Science, Google, and Geenmedical databases. Over 2 co-authors assessed the quality of the articles and extracted the data independently. The data acquired were statistically analyzed with the statistical software of Revman and Stata.

Results:

The ADA Group achieved a higher incidence of psoriasis (odds ratio [OR] = 0.658, 95% confidence interval [CI] [0.471–0.919]); Females achieved a higher incidence of psoriasis than males (OR = 1.941, 95%CI [1.326–2.843], P < .05); Smoking up-regulated the incidence of psoriasis (OR = 1.679, 95%CI [1.237–2.279], P < .05); The interval of medication was over 1 year, and the interval of medication applying IFX was longer than that of the ADA Group; most cases could be relieved by using local hormone, phototherapy, or systemic hormone therapy under the strategy of biological agents.

Conclusions:

The frequency of reported in IBD exceeds those of other autoimmune diseases, and the ADA treatment for IBD is safer than IFX. Psoriasis is more common in females than in males. Smoking refers to one of risk factors of psoriasis.
Familial chylomicronemia syndrome due to a heterozygous deletion of the chromosome 8 treated with the apoCIII inhibitor volanesorsen
Authors: Tünnemann-Tarr Adrienn , Scharnagl Hubert , Katzmann Julius L. , Stürzebecher Paulina , Laufs Ulrich
Published: October 2021

Rationale:

Familial chylomicronemia syndrome is a congenital, severe form of hypertriglyceridemia associated with increased risk of acute pancreatitis. Treatment options are limited.

Patient concerns:

A 52-year-old woman was referred with recurrent pancreatitis and severe hypertriglyceridemia to our lipid clinic.

Diagnosis:

Laboratory examination showed elevated serum triglyceride concentrations of 8090 mg/dL (90 mmol/L). Lipid electrophoresis showed a type V phenotype with positive chylomicrons. Genetic investigation revealed a novel heterozygous large deletion of the lipoprotein lipase gene on chromosome 8. A familial chylomicronemia syndrome was diagnosed. Other causes of hypertriglyceridemia were excluded.

Interventions:

Fibrates and diet did not lower triglyceride levels. Therefore, treatment with the apolipoprotein CIII (apoCIII) inhibitor volanesorsen was initiated.

Outcomes:

After 3 months of treatment, a 90% reduction of triglycerides was observed. ApoCIII concentrations were reduced by 90% in the total and by 61% in the chylomicron-free serum. Treatment was well tolerated with only minor local reaction after the first application. The platelet count was monitored weekly and did not decrease <150 cells/μL.

Lessons:

This case report shows that inhibition of apoCIII potently reduces serum triglycerides in patients with heterozygous monogenetic deletion of the lipoprotein lipase gene. Follow-up will show the effect on recurrent episodes of pancreatitis.