bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications
Authors: Wieslander Cecilia K. , Grimes Cara L. , Balk Ethan M. , Hobson Deslyn T. G. , Ringel Nancy E. , Sanses Tatiana V. D. , Singh Ruchira , Richardson Monica L. , Lipetskaia Lioudmila , Gupta Ankita , White Amanda B. , Orejuela Francisco , Meriwether Kate , Antosh Danielle D.
Published: October 2023

OBJECTIVE:

To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications.

DATA SOURCES:

PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022.

METHODS OF STUDY SELECTION:

The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies.

TABULATION, INTEGRATION, AND RESULTS:

Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy.

CONCLUSION:

Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42021234511.
Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic
Authors: Simon Sophie , John Sid , Lisonkova Sarka , Razaz Neda , Muraca Giulia M. , Boutin Amélie , Bedaiwy Mohamed A. , Brandt Justin S. , Ananth Cande V. , Joseph K. S.
Published: October 2023

OBJECTIVE:

To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States.

METHODS:

We carried out a retrospective study of all live births and fetal deaths in the United States, 2015–2021, with data obtained from the natality, fetal death, and linked live birth–infant death files of the National Center for Health Statistics. Analyses were carried out among all singletons; singletons of patients with prepregnancy diabetes, prepregnancy hypertension, and hypertensive disorders of pregnancy; and twins. Outcomes of interest included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, postterm birth, and perinatal death. Interrupted time series analyses were used to estimate changes in the prepandemic period (January 2015–February 2020), at pandemic onset (March 2020), and in the pandemic period (March 2020–December 2021).

RESULTS:

The study population included 26,604,392 live births and 155,214 stillbirths. The prepandemic period was characterized by temporal increases in preterm birth and preterm labor induction or cesarean delivery rates and temporal reductions in macrosomia, postterm birth, and perinatal mortality. Pandemic onset was associated with absolute decreases in preterm birth (decrease of 0.322/100 live births, 95% CI 0.506–0.139) and preterm labor induction or cesarean delivery (decrease of 0.190/100 live births, 95% CI 0.334–0.047) and absolute increases in macrosomia (increase of 0.046/100 live births), postterm birth (increase of 0.015/100 live births), and perinatal death (increase of 0.501/1,000 total births, 95% CI 0.220–0.783). These changes were larger in subpopulations at high risk (eg, among singletons of patients with prepregnancy diabetes). Among singletons of patients with prepregnancy diabetes, pandemic onset was associated with a decrease in preterm birth (decrease of 1.634/100 live births) and preterm labor induction or cesarean delivery (decrease of 1.521/100 live births) and increases in macrosomia (increase of 0.328/100 live births) and perinatal death (increase of 9.840/1,000 total births, 95% CI 3.933–15.75). Most changes were reversed in the months after pandemic onset.

CONCLUSION:

The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a transient decrease in obstetric intervention (especially preterm labor induction or cesarean delivery) and a transient increase in perinatal mortality.
Jackfruit waste: an invented anticancer therapy using Jacalin lectin from jackfruit seed
Authors: Ghosh Puja , K.M. Muhasina , Pandey Neelaxi , Basavan Duraiswamy
Published: October 2023

Every food source contains both edible and inedible waste components. Millions of tonnes of trash from the food business are made from fruits, and these wastes are containing higher-value medicinal components, such as alkaloids, flavonoids, phenolic contents, a huge amount of proteins and secondary metabolites. These bioactive phytoconstituents are being used for the treatment of many serious fatal diseases. So, utilizing the recovered bioactive molecules from food wastes as functional ingredients offers a long-term alternative source of therapeutically active components that will lead to the discovery of novel phytoconstituents or novel treatment approaches. The goal of this systematic study is to provide an overview of the jackfruit (Artocarpus heterophyllus Lam, Moraceae) edible byproducts, such as jackfruit seeds that are largely neglected. This seed contains numerous bioactive lead molecules, such as carbohydrate-binding protein jacalin, which exhibits potent anticancer activity against colon cancer, blood cancer and breast cancer as well as can enlighten the new possible treatment approaches in targeted therapy and photodynamic chemotherapy. Moreover, jackfruit waste seed can be taken as a dietary food, which is having property to prevent and treat cancer and other lifestyle diseases. The works that have been carried out to utilize jackfruit waste other than the juicy edible bulbs have been reviewed in this article.
A late relapse thymoma and pure red cell aplasia case with an over 5 years of clinical response under everolimus
Authors: Köksoy Elif B. , Akbulut Hakan
Published: October 2023

Although several agents showed some clinical activity in patients with recurrent thymoma, there is no standard treatment option. Here, we report a late relapse thymoma and pure red cell aplasia case, responsive to everolimus with over 5 years of clinical benefit following multiple lines of treatment. Everolimus controlled the rapidly progressive disease in our patient without significant toxicity.
Analysis of the effect of Ivor-Lewis esophagectomy and McKeown esophagectomy on perioperative anxiety and depression in patients with esophageal cancer
Authors: Du Jun , Kang Zhuangzhuang , Zhao Zhili , Wu Han , Chen Yimin , Zhang Chensong , Chen Yuzhong , Liang Wanqing , wang Qingkang , Ma Jiachi
Published: October 2023

To compare the effects of Ivor-Lewis esophagectomy and McKeown esophagectomy on perioperative anxiety and depression in patients with esophageal cancer. Sixty-three patients with stage I-III middle and lower esophageal carcinoma from June 2021 to December 2022 were randomly divided into observation group (n = 32) treated with laparoscopic Ivor-Lewis esophagectomy and control group (n = 31) treated with laparoscopic McKeown esophagectomy. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were measured on the second day of admission and the fifth day after surgery to assess the presence of depression and anxiety. The preoperative and postoperative clinical data of both groups were compared, and multivariate analysis was used to identify risk factors associated with depression and anxiety in patients with esophageal cancer. There was no significant difference in SDS and SAS standard scores between the observation group and the control group (P > 0.05). The postoperative SDS and SAS scores in the control group were significantly higher than those before and after operation in the observation group (P < 0.01). According to univariate analysis, patients with TNM stage III, tumor diameter greater than 3 cm, postoperative complications, radical McKeown esophagectomy, and C-reactive protein levels above 10 mg/L had a higher incidence of depression and anxiety (P < 0.05). Multivariate logistic analysis showed that TNM stage III (depression: OR 1.683, 95 CI 1.429–1.861; Anxiety: OR 1.739, 95 CI 1.516–1.902), postoperative complications (depression: OR 2.345, 95 CI 1.435–3.891; Anxiety: OR 1.872, 95 CI 1.372–3.471), surgical approach (depression: OR 1.609, 95 CI 1.502–3.193; Anxiety: OR 1.658, 95 CI 1.469–2.059), and C-reactive protein (depression: OR 2.260, 95 CI 1.157–4.059; Anxiety: OR 0.373, 95 CI 0.253–0.976) were all independent factors for depression and anxiety in patients after esophageal cancer surgery (P < 0.05). The Ivor-Lewis esophagectomy has the advantages of fewer complications and low inflammatory response, which can help alleviate anxiety and depression and improve patients’ quality of life and prognosis.
Life's Essential 8 and risk of non-communicable chronic diseases: Outcome-wide analyses
Authors: Yu Yuetian , Sun Ying , Yu Yuefeng , Wang Yuying , Chen Chi , Tan Xiao , Lu Yingli , Wang Ningjian
Published: October 2023

Background:

Life's Simple 7, the former construct of cardiovascular health (CVH) has been used to evaluate adverse non-communicable chronic diseases (NCDs). However, some flaws have been recognized in recent years and Life's Essential 8 has been established. In this study, we aimed to analyze the association between CVH defined by Life's Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions (PAFs) of low-moderate CVH scores in the 44 NCDs.

Methods:

In the UK Biobank, 170,726 participants free of 44 common NCDs at baseline were included. The Life's Essential 8 composite measure consists of four health behaviours (diet, physical activity, nicotine exposure, and sleep) and four health factors (body mass index, non-high density lipoprotein cholesterol, blood glucose, and blood pressure), and the maximum CVH score was 100 points. CVH score was categorized into low, moderate, and high groups. Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition (ICD-10) code using linkage to national health records until 2022. Cox proportional hazard models were used in this study. The hazard ratios (HRs) and PAFs of 44 NCDs associated with CVH score were examined.

Results:

During the median follow-up of 10.85 years, 58,889 incident NCD cases were documented. Significant linear dose-response associations were found between higher CVH score and lower risk of 25 (56.8%) of 44 NCDs. Low-moderate CVH (<80 points) score accounted for the largest proportion of incident cases in diabetes (PAF: 80.3%), followed by gout (59.6%), sleep disorder (55.6%), chronic liver disease (45.9%), chronic kidney disease (40.9%), ischemic heart disease (40.8%), chronic obstructive pulmonary disease (40.0%), endometrium cancer (35.8%), lung cancer (34.0%), and heart failure (34.0%) as the top 10. Among the eight modifiable factors, overweight/obesity explained the largest number of cases of incident NCDs in endocrine, nutritional, and metabolic diseases (35.4%), digestive system disorders (21.4%), mental and behavioral disorders (12.6%), and cancer (10.3%); however, the PAF of ideal sleep duration ranked first in nervous system (27.5%) and neuropsychiatric disorders (9.9%).

Conclusions:

Improving CVH score based on Life's Essential 8 may lower risk of 25 common NCDs. Among CVH metrics, avoiding overweight/obesity may be especially important to prevent new cases of metabolic diseases, NCDs in digestive system, mental and behavioral disorders, and cancer.
Physician Assessment of ChatGPT and Bing Answers to American Cancer Society’s Questions to Ask About Your Cancer
Authors: Janopaul-Naylor James R. , Koo Andee , Qian David C. , McCall Neal S. , Liu Yuan , Patel Sagar A.
Published: October 2023

Objectives:

Artificial intelligence (AI) chatbots are a new, publicly available tool for patients to access health care–related information with unknown reliability related to cancer-related questions. This study assesses the quality of responses to common questions for patients with cancer.

Methods:

From February to March 2023, we queried chat generative pretrained transformer (ChatGPT) from OpenAI and Bing AI from Microsoft questions from the American Cancer Society’s recommended “Questions to Ask About Your Cancer” customized for all stages of breast, colon, lung, and prostate cancer. Questions were, in addition, grouped by type (prognosis, treatment, or miscellaneous). The quality of AI chatbot responses was assessed by an expert panel using the validated DISCERN criteria.

Results:

Of the 117 questions presented to ChatGPT and Bing, the average score for all questions were 3.9 and 3.2, respectively (P < 0.001) and the overall DISCERN scores were 4.1 and 4.4, respectively. By disease site, the average score for ChatGPT and Bing, respectively, were 3.9 and 3.6 for prostate cancer (P = 0.02), 3.7 and 3.3 for lung cancer (P < 0.001), 4.1 and 2.9 for breast cancer (P < 0.001), and 3.8 and 3.0 for colorectal cancer (P < 0.001). By type of question, the average score for ChatGPT and Bing, respectively, were 3.6 and 3.4 for prognostic questions (P = 0.12), 3.9 and 3.1 for treatment questions (P < 0.001), and 4.2 and 3.3 for miscellaneous questions (P = 0.001). For 3 responses (3%) by ChatGPT and 18 responses (15%) by Bing, at least one panelist rated them as having serious or extensive shortcomings.

Conclusions:

AI chatbots provide multiple opportunities for innovating health care. This analysis suggests a critical need, particularly around cancer prognostication, for continual refinement to limit misleading counseling, confusion, and emotional distress to patients and families.
Complex Autism Spectrum Disorder: Structural Determinants of Health and Their Impact on the Diagnosis
Authors: Canale Sarah , Weissman Britany , Noroña Carmen Rosa , Fernández-Pastrana Ivys , Adolphe Soukaina , Christiansen Audrey , Reddy Arathi , Augustyn Marilyn
Published: October 2023

CASE:

Emmanuel is a 6.5-year-old boy who was referred to your evaluation clinic for concerns about his social skills and communication. He arrived in the United States (US) 1 year ago after an immigration trajectory that began in Haiti when he was aged 3 years; passed through Mexico, where the family was in various shelters for over a year; and concluded 2 years later, with the family eventually settling in an urban center in the northeastern United States. While in Mexico, the family was living in a camp without access to utilities. They faced significant food insecurity and experienced multiple relocations because of fears of physical safety.

Emmanuel's native language is Haitian Creole, but he learned some Spanish during the year spent in Mexico. Now in the United States, he has been enrolled for the last year in the public school system, where he participates in an inclusion English as a Second Language kindergarten classroom. The school has expressed concern about several behaviors including bolting from the classroom, shouting out inappropriately, and taking food from other children's lunches.

On initial meeting with a DBP clinician, Emmanuel's parents report that they do not have any concerns at home about his behavior, although they do feel that he “talks less than his 3 older siblings.” The 6-person household is currently living in one-room, temporary housing; they deny current food insecurity.

As part of his evaluation, you perform an Autism Diagnostic Observation Scale–2 Module 3 in English with the support of an in-person Haitian Creole interpreter. Emmanuel does not make eye contact throughout the evaluation but does respond to your questions in a combination of English and Haitian Creole. He can define the concept of a “friend” but cannot name one of his own friends. He is not able to engage in the demonstration task with words but does use gestures to indicate the actions involved in brushing teeth. His free play is perseverative and centers around fighting between the action figures.

Brief cognitive testing reveals normal nonverbal intelligence. He is unable to decode in English on achievement testing. The family completes a Social Responsiveness Scale in English, which shows normal scores except in the repetitive behaviors section, where the family endorses pacing and some restricted interests, particularly around video games.

He is not yet on an Individualized Education Plan, and there have been no formal assessments from the school except for language dominance testing indicating that his dominant language is Haitian Creole, with emerging English skills. What specific topics are unique to the evaluation for autism in an English language learner with a significant trauma history? What factors should be considered when assessing a child with a history of immigration trauma?
Assessing Parental Perceptions of Meaningful Outcomes for Children with Autism Spectrum Disorder
Authors: Close Meredith , Aberbach Gabriella , Chan Eugenia , Harstad Elizabeth
Published: October 2023

Background:

Outcomes of children diagnosed with autism spectrum disorder (ASD) generally focus on cognition, language, behavioral, and adaptive functioning, yet it is unknown whether this reflects patient and caregiver priorities.

Objective:

Identify parental perceptions of ASD outcomes and identify whether health care providers are currently addressing these concerns.

Methods:

Participant were 60 parents of school-aged children previously diagnosed with ASD participating in a larger autism outcomes study. Parents answered open-ended question, “What aspect of your child's functioning matters most for your child at this time?” They also ranked a list of outcome categories (thinking and reasoning skills, daily living skills, etc). Parents answered a second open-ended question “What should healthcare providers be asking about how your child is doing, that they may not be currently asking?” Open-ended independent coding and thematic analysis were used to identify themes for the open-ended questions.

Results:

The most common themes identified with “what aspect of your child's functioning matters most” were “Social,” “Communication,” “Emotional,” and “Behavior.” These were similar to the results of a ranking question in which parents ranked “Communicating with and understanding others,” “Social skills,” and “Behavior” as most important. “Emotional” was a unique theme, although there is potential overlap between this and the theme of “Behavior.” The most common theme identified with the question about what health care providers should be asking was “Social,” followed by “Nothing.”

Conclusion:

This study demonstrates that parental concerns largely match previous outcome categories, with the exception of a theme identified as “Emotional” which may overlap with “Behavior.”
AMNIOTIC MEMBRANE GRAFTING FOR A CASE OF BILATERAL GIANT FULL-THICKNESS MACULAR HOLE IN ALPORT SYNDROME AFTER CATARACT SURGERY
Authors: Roubelat François-Philippe , Gualino Vincent , Fournié Pierre R. , Soler Vincent J.
Published: October 2023

Purpose:

The purpose of this study was to describe the surgical management of bilateral giant full-thickness macular hole with sudden onset two months after cataract surgery in a patient with Alport syndrome.

Methods:

This was an observational, single-case report.

Results:

A 54-year-old woman with a history of Alport syndrome presented with severe bilateral visual loss two months after cataract surgery. The diagnosis of bilateral giant full-thickness macular hole was made. We found the absence of the internal limiting membrane and the inability to lift and peel a continuous posterior hyaloid sheet during surgical management with 25-gauge pars plana vitrectomy (left eye). Amniotic membrane grafting followed by gas tamponade were performed for hole closure. The hole remained closed but vision was poorly restored two months after.

Conclusion:

Cataract surgery in patients with Alport syndrome could promote early development of giant full-thickness macular hole. Collagen defects could underlie internal limiting membrane absence and the inability to properly peel the posterior hyaloid.
A NOVEL FINDING IN THE DIAGNOSIS OF PRIMARY VITREORETINAL LYMPHOMA: A CASE REPORT
Authors: Maleki Arash
Published: October 2023

Purpose:

Introduce a unique case of primary vitreoretinal lymphoma with a new optical coherence tomography finding.

Methods:

A case report. A 67-year-old healthy man with complaints of blurry vision in his right eye.

Results:

The patient's visual acuity was 20/60 and 20/20 in the right and left eyes, respectively. Anterior segment examination of the right eye demonstrated mild inflammation. Dilated fundoscopy revealed 2+ vitreous haze and 4+ disk edema. Optical coherence tomography of the macula in the right eye revealed optic nerve head swelling and thickening of the retina. Fluorescein angiography demonstrated mild leakage and staining of vessels along the inferotemporal arcade in the right eye. Labs were within normal limits except positive Herpes simplex virus 1 IgG. Initially, the patient was treated for herpetic panuveitis for 3 weeks with a favorable response. However, the clinical condition deteriorated as a new abnormality was identified in the macular region of the right eye through optical coherence tomography. Considering intraocular lymphoma as a potential diagnosis, the patient underwent a diagnostic vitrectomy. The vitreous sample analysis confirmed primary vitreoretinal lymphoma through immunohistochemistry and flow cytometry. The patient exhibited a rapid response after the initiation of intravenous and intravitreal methotrexate treatment.

Conclusion:

The presence of subretinal fluid accompanied by suspended hyperreflective lesions originating from the roof of the subretinal fluid pocket on the optical coherence tomography of macula “stalactite sign” may serve as a characteristic sign indicative of primary vitreoretinal lymphoma; however, further investigation using robust studies is necessary to examine this hypothesis.
VITREORETINAL ABNORMALITIES DURING MACULAR HOLE REPAIR IN ALPORT SYNDROME
Authors: Zhou Brenda , Heisel Curtis J. , Zhu Ivy , Gill Manjot K.
Published: October 2023

Purpose:

The purpose of the study was to describe abnormal vitreoretinal findings during macular hole repair in Alport syndrome.

Methods:

A case report of preoperative, intraoperative, and postoperative findings related to macular hole surgery in a patient with Alport syndrome was discussed.

Results:

A 50-year-old woman with Alport syndrome was found to have bilateral full-thickness macular holes. Surgery was recommended for her left eye given recent onset of vision loss and smaller hole size (313 μm). Intraoperatively, the vitreous was found to have fine fibrillar strands and to be abnormally adherent to the retinal surface. There was little to no internal limiting membrane present. Vitrectomy was performed with posterior cortical hyaloid peeling and 15% C3F8 gas tamponade. Two months after surgery, the macular hole was successfully closed.

Conclusion:

Abnormal vitreous composition and adherence to the retinal surface may contribute to macular hole formation in patients with Alport syndrome. Standard surgical approaches including internal limiting membrane peeling may not be feasible, although thorough removal of the posterior cortical hyaloid may be sufficient to achieve macular hole closure.
Current opinion: advances in machine perfusion and preservation of vascularized composite allografts – will time still matter?
Authors: Muss Tessa E. , Loftin Amanda H. , Oh Byoung Chol , Brandacher Gerald
Published: October 2023

Purpose of review

A major hurdle hindering more widespread application of reconstructive transplantation is the very limited cold ischemia time (CIT) of vascularized composite allografts (VCAs). In this review, we discuss cutting edge machine perfusion protocols and preservation strategies to overcome this limitation.

Recent findings

Several preclinical machine perfusion studies have demonstrated the multifactorial utility of this technology to extend preservation windows, assess graft viability prior to transplantation and salvage damaged tissue, yet there are currently no clinically approved machine perfusion protocols for reconstructive transplantation. Thus, machine perfusion remains an open challenge in VCA due to the complexity of the various tissue types. In addition, multiple other promising avenues to prolong preservation of composite allografts have emerged. These include cryopreservation, high subzero preservation, vitrification and nanowarming. Despite several studies demonstrating extended preservation windows, there are several limitations that must be overcome prior to clinical translation. As both machine perfusion and subzero preservation protocols have rapidly advanced in the past few years, special consideration should be given to their potential complementary utilization.

Current and emerging machine perfusion and preservation technologies in VCA have great promise to transform the field of reconstructive transplantation, as every extra hour of CIT helps ease the complexities of the peri-transplant workflow. Amongst the many advantages, longer preservation windows may allow for elective procedures, improved matching, establishment of novel immunomodulatory protocols and global transport of grafts, ultimately enabling us the ability to offer this life changing procedure to more patients.
Penile fracture: a case series of 18 patients
Authors: Molla Yohannis D. , Erku Belay A. , Kassa Samrawit A. , Alemu Hirut T. , Mekonnen Desyibelew C.
Published: October 2023

Introduction:

Penile fractures are a rare urological emergency. It is defined as ‘rupture of the tunica albuginea of one or both corpora cavernosa. The corpus spongiosum and the urethra may also be involved in this process.’ The tunica albuginea is stiff and significantly thinner during erection than in the flaccid state, which is when injury generally happens.

Method:

This case series was completed between January 2018 and January 2023 at the Department of General Surgery. Eighteen patients suspected of having penile fractures participated in were included this study. All patients were thoroughly evaluated upon hospital admission to identify the diagnosis, length of time since the accident, the site of the fracture, the extent of the penile hematoma, occurrence of blood at the external meatus, presence of urine retention, and intraoperative outcomes.

Results:

The patients were between the ages of 24 and 70, with a mean age of 37. The duration before the presentation ranged from 7 h to 1 month (the median was 22 h). Sexual intercourse was the cause in 12 (66%) cases, rolling in the bed in three cases (16%), and blunt trauma in three cases (kicking and the edge of the bed) (16%). Pain and swelling were present in all of the patients. In 15 patients (or 83%), there was evidence of penile deviation. At presentation, 15 (72%) patients reported experiencing rapid detumescence, discomfort, and penile swelling after hearing a cracking (popping) sound. None of these individuals experienced urine retention or urethral hemorrhage, and all were emptied on their own following the episode. Physical examination showed penile ecchymosis, swelling, and substantial discomfort when the penile shaft was examined. All but three patients had an evident penile deformity. Surgery was performed under spinal anesthesia in 14 (77.7%) patients. Four patients with a delayed presentation (more than 1 week) were managed conservatively.

Conclusion:

As a true urologic emergency, penile fractures should be treated immediately to reduce pain and swelling and ensure better functional and esthetic outcomes. Despite taking more time, a subcoronal circumcising degloving incision is the ideal method because it is exploratory and esthetically pleasing.
Dramatic Shift in the Etiology of Genital Ulcer Disease Among Patients Visiting a Sexually Transmitted Infections Clinic in Lilongwe, Malawi
Authors: Chen Jane S. , Matoga Mitch M. , Gaither Claudia F. , Jere Edward , Mathiya Esther , Bonongwe Naomi , Krysiak Robert , Banda Gabriel , Hoffman Irving F. , Miller William C. , Juliano Jonathan J. , Rutstein Sarah E.
Published: October 2023

Background

Genital ulcer diseases (GUDs) are a common syndrome associated with sexually transmitted infections. Genital ulcer diseases increase the risk of HIV transmission, necessitating appropriate diagnosis and treatment. We provide an updated GUD etiology assessment in Malawi to guide diagnostic development and treatment algorithms.

Methods

We enrolled patients 18 years or older presenting with GUD at a sexually transmitted infection clinic in Lilongwe, Malawi, between May and October 2021. We purposively sampled by HIV status. Swabs of ulcers were tested forTreponema pallidum, herpes simplex virus (HSV)-1 and HSV-2,Haemophilus ducreyi, andChlamydia trachomatisusing polymerase chain reaction. Blood was collected for syphilis and HSV-2 serologies and acute HIV testing. Participants were treated per Malawi guidelines. Ulcer resolution (size reduced by >50%) was evaluated 14 days later.

Results

Fifty participants enrolled (30 without HIV, 2 with acute HIV infection, 18 with HIV seropositivity; 32 men, 18 women). Forty-six (92%) had an etiology identified. Syphilis was more common among those without HIV (22 of 30 [73%]) than participants with HIV (PWH; 8 of 20 [40%];P= 0.04). Herpes simplex virus was more common among PWH (11 of 20 [55%]) than participants without (2 of 30 [7%];P= 0.0002). One-fifth (9 of 50 [18%]) hadH. ducreyi. Among those who returned for follow-up (n = 45), 9 (20%) had unresolved ulcers; persistent GUD was slightly more common in PWH (6 of 19 [32%]) than participants without (3 of 26 [12%];P= 0.14).

Conclusions

We observed a dramatic increase in syphilis ulcer proportion in a population whose GUDs were previously HSV predominant. Observed differences in etiology and resolution by HIV status could play an important role in the ongoing transmission and treatment evaluation of GUD.
Prospective Laboratory Evaluation of the cobas Plasma Separation Card for HIV and Treponema pallidum Antibody Analysis
Authors: Vanroye Fien , Van den Bossche Dorien , Vercauteren Koen
Published: October 2023

Background

The cobas Plasma Separation Card (PSC; Roche Diagnostics) was developed for HIV viral load testing. This study evaluates the performance of HIV and Treponema pallidum (Tp) antibody (Ab) detection on PSCs as an alternative to dried blood spots (DBSs).

Methods

EDTA whole blood samples were collected from HIV-positive (n = 100), HIV-negative (n = 50), Tp-positive (n = 100), and Tp-negative patients (n = 50) and spotted on DBS and PSC. Antibody detection performance was evaluated for HIV Ab using the Genscreen ULTRA HIV Ag-Ab test (Bio-Rad) and for Tp Ab using the Syphilis Total Ab test (Bio-Rad). Plasma was used as a reference specimen.

Results

Receiver operating characteristic curve analysis for DBS and PSC generated areas under the curve (AUC + 95% confidence interval) of 0.985 (0.960–1.000) and 0.987 (0.973–1.000) for HIV Ab and 1.000 (1.000–1.000) and 0.996 (0.983–1.000) for Tp Ab, respectively. Receiver operating characteristic areas under the curve were not significantly different between DBS and PSC for HIV or TP Ab. At selected cutoff values rendering at least 99% sensitivity for HIV Ab detection, the specificity was 96% on DBS and 68% on PSC. For Tp Ab detection at 90% sensitivity, 100% specificity is reached on both DBS and PSC (exceeding the required 95%). However, the median quantitative HIV and Tp Ab signal of positive samples significantly decreased in PSC compared with DBS and plasma.

Conclusions

Although receiver operating characteristic analysis does not seem to indicate significant differences in performance between DBS and PSC, the significant reduction in quantitative Ab detection signal dictates card composition optimization before its use for HIV and Tp Ab detection can be advised.
Brazilian Clinical Practice Guidelines for Sexually Transmitted Infections That Cause Urethral Discharge: Assessment According to the AGREE II and Critical Analysis Based on the WHO Recommendations
Authors: Gaspar Pâmela Cristina , Barreto Jorge Otávio Maia , Bigolin Alisson , Miranda Angélica E. , Aires Júnior Luiz F. , Bazzo Maria Luiza , Díaz Bermúdez Ximena Pamela , Benzaken Adele Schwartz
Published: October 2023

Background

Sexually transmitted infections (STI) can have severe consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs (PCDT-IST). This study assessed the quality of PCDT-IST (2021) and reviewed the main recommendations for the management of STI that cause urethral discharge compared with the World Health Organization (WHO) STI Guidelines.

Methods

The PCDT-IST (2021) quality was independently assessed by 4 appraisers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). The PCDT-IST (2021) and the WHO Guidelines for the Management of Symptomatic STI (2021) were compared considering 14 different assessment domains.

Results

The PCDT-IST (2021) scores in the AGREE II domains were: Rigor of Development (58%), Applicability (35%), Editorial Independence (38%), Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%). The overall score was 67%, and all appraisers recommended the Brazilian guideline. Regarding the PCDT-IST (2021) and the WHO STI Guidelines (2021) comparation, 10 domains would be relevant for further reviewing the Brazilian recommendations: Diagnostic tests; Etiological approach; Treatment for recurrent urethral discharge; Treatment for urethritis without etiological agent identification; Treatment for gonococcal urethritis; Treatment for chlamydial urethritis; Retreatment for gonococcal infections; Treatment for Mycoplasma genitalium urethritis; Treatment for Trichomonas vaginalis urethritis; 10. Flowcharts.

Conclusions

The PCDT-IST (2021) has a reasonable degree of quality. However, the domains of Applicability, Rigor of Development, and Editorial Independence must be better ensured. The guidelines comparison will help to select key topics that should be addressed with priority in the following national STI guidelines updates.
Sexually Transmitted Infections and the Risk of Reinfection Within 12 Months: A Population-Based Cohort
Authors: Kumbaroff Zoe , Duff Putu , Saxton Peter , Sonder Gerard J.B. , Thirkell Callum , Scott Julia , Walls Tony , Anglemyer Andrew
Published: October 2023

Background

Chlamydia, gonorrhea, and syphilis are common sexually transmitted infections that disproportionately affect specific groups in New Zealand (NZ). Predictors of reinfection are not well studied in NZ but could inform public health strategies to decrease sexually transmitted infection (STI) incidence.

Methods

New Zealand–wide chlamydia, gonorrhea, and syphilis cases during 2019 were identified using nationally collected data. Cases were followed-up to identify reinfection with the same STI within 12 months of initial infections. Logistic regression models were used to identify predictors for each STI reinfection.

Results

Determinants identified for increased odds of chlamydia reinfection were age groups 16–19 and 20–24 years, females, Māori and Pacific peoples, cases in the Northern region, and cases with at least one test before the initial infection. Age 40 years and older was associated with lower odds of gonorrhea reinfection, as was being of Asian ethnicity, living in Midland or Southern regions, and reporting heterosexual behavior. Region was the only statistically significant predictor for syphilis reinfection, with higher odds of reinfection for people living in the Central region.

Conclusions

Our findings reflect disproportionate STI rates for some groups in NZ, with younger age groups, Māori and Pacific peoples, men who have sex with men, and people living in the Northern region experiencing higher odds of reinfection. Groups identified with higher odds for reinfection require increased access to culturally responsive health services to treat, understand, and prevent possible reinfection. Changes to current public health strategies could include culturally specific behavioral counseling, and improvements to and adherence to effective contract tracing.
Is Ophthalmia Neonatorum Associated With Invasive Bacterial Infection? A Single-Center Retrospective Study
Authors: St-Onge-St-Hilaire Alexandra , Boutin Ariane , Gravel Jocelyn
Published: October 2023

Objective

Ophthalmia neonatorum (ON) is a conjunctivitis occurring in neonates and can be caused by multiple bacterial pathogens. The risk of invasive bacterial infection (IBI) in neonates with ON is poorly known. Our objectives were to document the association of ON with IBI in term neonates and to investigate practice variation.

Methods

This was a retrospective observational study of all neonates who presented to a single emergency department (ED) between January 2018 and December 2019. Participants were all children with a final diagnosis of ON according to the treating physician as registered in the ED computerized database. Newborns with craniofacial malformations and premature infants were excluded. The primary outcome was IBI as defined by growth of any bacterial pathogen in the blood or cerebrospinal fluid. Perinatal risk factors, ED visit details (symptoms on presentation, management, and treatment plan) as well as complications (ocular morbidity, death, and unscheduled return visits) were collected. Data were analyzed using descriptive statistics.

Results

Fifty-two term neonates were included. There were no cases of IBI associated with ON (0%; 95% confidence interval [CI], 0%–6.9%). Six ocular bacterial infections were identified, one of which wasChlamydia trachomatis. Although there were no IBIs, ocular complications, deaths, or unscheduled return visits to the ED, there was a wide variation in physician's management of ON. Physicians ordered investigations in 49% (95% CI, 34%–62%) of neonates, prescribed antibiotics to 87% (95% CI, 74%–94%), and involved specialists in 39% (95% CI, 27%–52%) of cases.

Conclusions

Emergency department presentations of term neonates with ON are associated with a low risk of IBI. A better understanding of the current practice variation is needed to inform clinical guidelines for the management of neonates with ON presenting to the ED.
Ready, Set, Move! Tracking Children's Modified Ride-On Car Use With a Custom Data Logger
Authors: Dean-Hergert Sarah M. , Papazian Christina , Barchus Rebecca , Barroero Chelsea , Schnare Wendy , Logan Samuel W. , Feldner Heather A. , Winfree Kyle N.
Published: October 2023

Purpose:

To create and implement a next-generation, custom data logger to automatically track modified ride-on car (MROC) use in home and community settings, establish feasibility of long-term remote collection of community MROC use data, describe trends of MROC use, and explore parent perception of the MROC.

Methods:

In this descriptive study, a custom data logger was constructed and integrated into MROCs using an Arduino Pro-Mini microprocessor to capture real-time use data remotely.

Results:

It is feasible to automatically track MROC use in home and community settings. On average, MROC use trends appear consistent with caregiver reports and show higher initial use with steadily decreasing frequency over time, and varying bout duration and play session length, despite favorable caregiver perceptions of the cars.

Conclusions:

Remote tracking of MROC use may decrease burden on busy families and provide clinicians with valuable technology use data.
Management strategies for severe Pseudomonas aeruginosa infections
Authors: Do Rego Hermann , Timsit Jean-François
Published: October 2023

Purpose of review

This review focuses on the management of severe Pseudomonas aeruginosa infections in critically ill patients.

Recent findings

Pseudomonas aeruginosa is the most common pathogen in intensive care; the main related infections are nosocomial pneumonias, then bloodstream infections. Antimicrobial resistance is common; despite new antibiotics, it is associated with increased mortality, and can lead to a therapeutic deadlock.

Carbapenem resistance in difficult-to-treat P. aeruginosa (DTR-PA) strains is primarily mediated by loss or reduction of the OprD porin, overexpression of the cephalosporinase AmpC, and/or overexpression of efflux pumps. However, the role of carbapenemases, particularly metallo-β-lactamases, has become more important. Ceftolozane-tazobactam, ceftazidime-avibactam and imipenem-relebactam are useful against DTR phenotypes (noncarbapenemase producers). Other new agents, such as aztreonam-ceftazidime-avibactam or cefiderocol, or colistin, might be effective for carbapenemase producers. Regarding nonantibiotic agents, only phages might be considered, pending further clinical trials. Combination therapy does not reduce mortality, but may be necessary for empirical treatment. Short-term treatment of severe P. aeruginosa infections should be preferred when it is expected that the clinical situation resolves rapidly.
Uptake of Gadolinium-Based Contrast Agents by Blood Cells During Contrast-Enhanced MRI Examination
Authors: Ruprecht Nico , Parakkattel Dixy , Hofmann Lukas , Broekmann Peter , Lüdi Nicola , Kempf Christoph , Heverhagen Johannes Thomas , von Tengg-Kobligk Hendrik
Published: October 2023

Objectives

Gadolinium-based contrast agents (GBCAs) are routinely used in magnetic resonance imaging (MRI) examinations. However, there is limited knowledge about the interaction with and distribution of the drug in human cells. This lack of knowledge is surprising, given that the first interaction of the drug occurs with blood cells. Moreover, recent studies reported gadolinium (Gd) deposition within organs, such as the brain. Hence, this study is aiming to determine the uptake of GBCA in blood cells of patients undergoing contrast-enhanced MRI (ce-MRI) examination.

Materials and Methods

Human blood was exposed to either gadoterate meglumine (Gd-DOTA) or Eu-DOTA in vitro or was collected from patients undergoing ce-MRI with Gd-DOTA. Uptake of contrast agents (CAs) by blood cells was quantified by Gd measurements using single-cell inductively coupled plasma mass spectrometry (SC-ICP-MS) or, to confirm Gd-DOTA uptake, by a complementary method using Eu-DOTA by time-resolved fluorescence spectroscopy, respectively.

Results

Uptake of Gd-DOTA or Eu-DOTA into white blood cells (WBCs) ex vivo was detectable by SC-ICP-MS and time-resolved fluorescence spectroscopy. The intracellular concentrations were estimated to be in the range of 1–3 μM. However, no CA uptake into erythrocytes was detected with either method. In total, 42 patients between 30 and 84 years old (24 men, 18 women) were enrolled. White blood cells' uptake of Gd was measured by SC-ICP-MS. Isolated WBCs from patients who underwent ce-MRI examination showed substantial Gd uptake; however, the studied patient group showed an inhomogeneous distribution of Gd uptake. Measurements immediately after MRI examination indicated 21–444 attogram/WBC, corresponding to an intracellular Gd concentration in the range from 0.2 to 5.5 μM.

Conclusions

This study confirms the ex vivo uptake of GBCA by WBCs and provides the first evidence that GBCA is indeed taken up by WBCs in vivo by patients undergoing ce-MRI examination. However, the observed Gd uptake in WBCs does not follow a log-normal distribution commonly observed in the fields of environmental studies, biology, and medicine. Whether cellular uptake of GBCA is linked to the observed deposition of Gd remains unclear. Therefore, studying the interaction between GBCA and human cells may clarify crucial questions about the effects of Gd on patients after MRI examinations.
Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap
Authors: Yu Zouzou , Jin Shengyang , Zang Mengqing , Zhu Shan , Li Shanshan , Han Tinglu , Chen Zixiang , Liu Yuanbo
Published: October 2023

Background

Complex soft tissue defects, which result from the surgical resection of sacral tumors, manifest as a combination of skin defects, dead space, infection, and prosthesis exposure. Because the traditional musculocutaneous flap lacks flexibility because of the close connection between the skin flap and the muscle component, the musculocutaneous flap is not suitable for reconstructing complex soft tissue defects where the dead space and skin defects are located at different sites. Furthermore, the perforator flap is also not appropriate for reconstructing complex defects because it lacks the muscular component. We considered the possibility of using the chimeric perforator propeller flap for reconstructing complex sacrococcygeal defects.

Methods

This study included 7 patients who underwent, between July 2007 and July 2021, the reconstruction of complex soft tissue defects of the sacrococcygeal region using a chimeric perforator propeller flap.

Results

Among the included cases, the etiologies were chordoma (n = 3), sacral tumor (n = 3), and squamous cell carcinoma (n = 1). In all the cases, vacuum-assisted closure therapy was used to treat wound infections before surgery. The average sizes of the skin and muscle flaps were 195.8 cm2 (range, 100–350 cm2) and 83.6 cm2 (range, 60–140 cm2), respectively. The superior gluteal artery was the source artery for the chimeric perforator propeller flap. The donor sites were primarily closed in all cases. One patient had delayed wound healing, and the secondary wound healed using conservative dressing changes. The other 6 flaps had no complications. The average follow-up time was 5.3 months (range, 1–9 months). Muscle weakness and compromised ambulation in the affected lower extremities were not observed in any of the patients. Furthermore, all 7 patients had no tumor recurrence, prosthesis exposure, and infection events in the sacrococcygeal region.

Conclusions

The chimeric perforator propeller flap may be an option for reconstructing complex soft tissue defects in the sacrococcygeal region.