bluuebunny/crossref_metadata_2025 huggingface dataset:
A rare disorder causing chronic joint pain in an adolescent
Authors: Millard Nicole
Published: January 2021

This article describes a patient with chronic knee pain and deformities of her hands and feet that led to a diagnosis of nail-patella syndrome, a rare autosomal dominant disorder.
The role of vaccine exemptions in the resurgence of measles
Authors: Nimblett-Clarke Avril
Published: January 2021

Measles (rubeola) is a highly contagious, vaccine-preventable illness. Since 2014, a resurging trend has been noted in the incidence of measles, an illness once eliminated. Low vaccination rates contribute to its resurgence. The most compelling reason for low vaccination rates is the availability and prevalence of nonmedical exemptions (NME), which are primarily based on religious and philosophical beliefs. This article reviews the effect of NMEs in measles resurgence and the moral and legal implications of these exemptions. Clinicians should be aware of this trend and be ready to educate and evaluate the validity of NME requests.
Clinical strategies for addressing obesity in infants and toddlers
Authors: Graf Michelle D. , Karp Sharon M. , Lutenbacher Melanie , Wasser Heather , Bushaw Andrea , Dietrich Mary S.
Published: January 2021

Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.
Reducing the wait
Authors: Atchley Megan Danielle , Kroll Nicole Peters , Etcher LuAnn
Published: January 2021

Today, healthcare providers are not only charged with providing high-quality evidence-based care to improve patient outcomes, but also with completing quick patient visits due to time constraints to necessitate financial reimbursement. This article summarizes current evidence to determine best practices for managing outpatient wait times and improve outcomes, satisfaction, quality, and continuity of care.
Outcomes of Telehealth-Delivered Physical Activity Programs in Adult Cancer Survivors: A Systematic Review
Authors: Blackwood Jennifer , Rybicki Kateri
Published: January 2021

Background and Purpose:

Reduced physical activity (PA) is associated with poor prognosis in cancer survivors. Clinicians and researchers have attempted to improve adherence to PA recommendations, essentially bridging the gap between the clinic and the home by incorporating telehealth technologies in patients with chronic diseases. However, various approaches to telehealth may be used and the effectiveness of these interventions in cancer survivors is unknown. The purpose of this systematic review was to describe the type of technology used and outcomes of telehealth-delivered PA programs in adult cancer survivors.

Methods:

A systematic review was performed to examine telehealth methods used to deliver PA exercise programs in adult cancer survivors. Databases searched for articles included PubMed/Ovid, MEDLINE/Web of Science, and CINAHL Complete via EBSCO. All articles that met the inclusion criteria were appraised by 2 reviewers independently and discussed against inclusion/exclusion criteria. The Cochrane Risk of Bias Assessment was used to assess study quality.

Results:

The search located 21 articles, and 5 met inclusion criteria. Articles included survivors from breast cancer (n = 3), prostate cancer (n = 1), and mixed sample (n = 1), including breast, cervical, endometrial, lung, leukemia, lymphoma, urinary, melanoma, rectal, oral, ovarian, and prostate cancer survivors. Sample size ranged from 41 to 339 and comprised 81.2% breast cancer survivors. PA interventions were delivered via telehealth by telephone calls (2 studies), smartphone apps (2 studies), and one used a combination of telephone calls and text messaging.

Limitations:

Selection bias is possible. Limited types of telehealth technologies were used.

Conclusions:

Limited evidence exists describing better outcomes of telehealth-delivered PA programs in cancer survivors than by traditional home exercise program instruction, and further study is indicated.
Atopic endotypes as a modulating factor for SARS-CoV-2 infection: mechanisms and implications
Authors: Huntley Kyle S. , Fine Lauren , Bernstein Jonathan A.
Published: January 2021

Purpose of review

Asthma patients are typically at increased risk for severe outcomes from viral respiratory infections. However, asthma and atopy do not appear to be overrepresented comorbidities in COVID-19 patients, and hypotheses attempt to explain this observation. As COVID-19 continues to spread globally, it is imperative to understand how disease outcomes may be influenced in this population to guide patient care.

Recent findings

Angiotensin converting enzyme 2 (ACE2) is the principal host cell receptor for SARS-CoV-2 entry and Transmembrane Protease Serine 2 (TMRSS2) is the main priming protease. Models have linked atopic endotypes to reductions in ACE2 and increases in TMRSS2 on respiratory epithelia. Epidemiologic and experimental findings imply alterations in ACE2 expression correlate with clinical COVID-19 disease, but limitations restrict the ability to draw direct conclusions.

There is reasonable evidence to assert atopic endotypes modulate COVID-19 susceptibility, but it remains premature to classify this association as protective or deleterious. Asthma is a heterogeneous disease and epidemiologic studies should focus on investigating COVID-19 outcomes by underlying endotype. Direct experimental and clinical evidence is needed to draw definitive conclusions on how the complex interplay of ACE2 and TMRSS2 affect viral entry.

Video abstract

https://www.dropbox.com/sh/9sfwqhz2h78sio3/AAB0JYd4MFzM5JjDFcYwz4CXa?dl=0
Comparison of Psychological and Physiological Stress in NICU Nurses
Authors: Brand M. Colleen , Shippey Holly , Hagan Joseph , Hanneman Sandra K. , Levy Barbara , Range Stefany , Wongsuwan Nattaya , Zodin Amy , Walden Marlene
Published: January 2021

Background:

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied.

Purpose:

To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift.

Methods:

Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models.

Results:

NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001).

Implications for Practice:

Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress.

Implications for Research:

Strategies are needed for reducing stress in NICU nurses who work night shift.
A Simple Technique to Facilitate Sheath Irrigation of Septic Flexor Tenosynovitis
Authors: Wolf Valeri , Samora Julie Balch
Published: January 2021

Septic flexor tenosynovitis is an aggressive hand infection that requires expedient attention. We describe the use of readily available red rubber catheters and arthroscopy tubing in operative irrigation of septic flexor tenosynovitis. The advantage of this technique over more open or invasive techniques is its simplicity, minimally invasive and tissue sparing nature, and rapid flow of fluid within the tight flexor sheath.
Osteoid Osteoma Ablation in the Hand Using CT-guided Radiofrequency: Methodology
Authors: Zinger Gershon , Adler Shana , Applbaum Yaakov , Peyser Amos
Published: January 2021

Osteoid osteoma (OO) is a painful benign vascular lesion rarely found in the hand. Treatment includes resection, usually done with a standard open approach. Radiofrequency uses radio waves to transmit energy to local tissue to ablate the lesion with thermal necrosis. It is often used for OO in the proximal extremities and spine but rarely in the hand. We present a case here of OO ablation using radiofrequency in the fourth metacarpal head. The procedure was minimally invasive using a 3 mm dorsal incision and computed tomography guidance. We illustrate the technique used here that was both effective and avoided injury to nearby neurovascular structures.
Novel Acetabular Hemiarthroplasty for Palliation of Periacetabular Metastatic Disease With Articular Bone Loss
Authors: Nelson Philip C. , Lockey Stephen D. , Wodajo Felasfa M.
Published: January 2021

Introduction:

Periacetabular metastatic disease is often successfully treated nonoperatively. Cases with extensive bone loss and the subchondral collapse of the acetabular dome require reconstruction to restore mobility. These procedures are associated with significant morbidity and postoperative complications.

Objectives:

The primary objective of this case study is to describe a novel “acetabular hemiarthroplasty” to manage the periacetabular metastatic disease with subchondral collapse and protrusio.

Materials and Methods:

Five consecutive patients with significant periacetabular bone loss and subchondral collapse were surgically managed with a novel acetabular hemiarthroplasty. The hospital records were retrospectively reviewed and outcomes at the most recent follow-up are reported.

Results:

Our findings suggest that acetabular hemiarthroplasty could be a valuable option for surgical palliation of periacetabular metastatic disease involving subchondral collapse and protrusio.

Conclusion:

This technique provides for the restoration of joint mechanics and weight bearing without the need for total hip arthroplasty. Compared with complex hip arthroplasty, the authors believe this novel acetabular hemiarthroplasty potentially reduces operative time and blood loss while substantially limiting the risk of dislocation.
Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China
Authors: Zhang He , Zheng Wen , Wu Shuo , Ma Jing-Jing , Wang Guang-Mei , Li Yong , Zheng Jia-Qi , Lyu Yuan , Xue Meng-Yang , Xu Feng , Wang Jia-Li , Chen Yu-Guo
Published: January 2021

Background:

Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.

Methods:

We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.

Results:

The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.

Conclusions:

Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China
Authors: Zhang Shu-Yuan , Tao Li-Yuan , Yang Yun-Yun , Kong Tao , Wu Cun-Jin , Wang Yang , Chen Jing-Zhou , Song Lei , Wang Yi-Bo , Hui Ru-Tai , Zhang Wei-Li
Published: January 2021

Background

Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs.

Methods

In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs.

Results

There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was –7.9 mmHg (95% CI, –9.9 to –5.9) in the brand-name drug group and –7.1 mmHg (95% CI, –9.1 to –5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2–2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment.

Conclusions

Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.
Type 2 Myocardial Infarction
Authors: Smer Aiman , Squires Ray W. , Aboeata Ahmed , Bowman Melissa J. , Mahlmeister Kasara A. , Medina-Inojosa Jose R. , Bonikowske Amanda R. , Patel Apurva , Del Core Michael , Williams Mark A.
Published: January 2021

Background:

Type 2 myocardial infarction (T2MI) is commonly encountered in clinical practice, yet little is known about this challenging condition. Outpatient cardiac rehabilitation (CR) is an integral component in the care of patients with MI. However, specific recommendations for CR, information on the feasibility of participation, and outcome measures for patients with T2MI are lacking.

Clinical Considerations:

The frequency of T2MI is markedly variable and depends on the studied population, disease definition, adjudication process, cardiac troponin assays, and cutoff values used to make the diagnosis of T2MI. Clinically, it is difficult to distinguish T2MI from type 1 MI or myocardial injury. Type 2 myocardial infarction occurs due to myocardial oxygen supply-demand mismatch without acute atherothrombotic plaque disruption and is associated with adverse short- and long-term prognoses. Currently, there are substantial gaps in knowledge regarding T2MI and there are no clear guidelines for the optimal management of these patients.

In this article, we present important current concepts surrounding T2MI including the definition, pathophysiology, epidemiology, diagnosis, prognosis, and management. We also discuss referral patterns to CR and participation rates and provide our experience with a case series of 17 patients. Very few patients with T2MI are referred to and participate in CR. Our small case series indicated that patients with T2MI respond favorably to CR and that exercise training following standard guidelines appears safe and is well tolerated.
The V˙E/V˙co 2 Slope During Maximal Treadmill Cardiopulmonary Exercise Testing
Authors: Arena Ross , Myers Jonathan , Harber Mathew , Phillips Shane A. , Severin Richard , Ozemek Cemal , Peterman James E. , Kaminsky Leonard A.
Published: January 2021

Purpose:

Cardiopulmonary exercise testing (CPX) is the gold standard approach for the assessment of cardiorespiratory fitness (CRF). The primary aim of the current study was to determine reference standards for the minute ventilation/carbon dioxide production (V˙E/V˙co
2) slope in a cohort from the “Fitness Registry and the Importance of Exercise: A National Database” (FRIEND) Registry.

Methods:

The current analysis included 2512 tests from 10 CPX laboratories in the United States. Inclusion criteria included CPX data on apparently healthy men and women: (1) age ≥20 yr; and (2) with a symptom-limited exercise test performed on a treadmill. Ventilation and V˙co
2 data, from the initiation of exercise to peak, were used to calculate the V˙E/V˙co
2 slope via least-squares linear regression. Reference values were determined for men and women by decade of life.

Results:

On average, V˙E/V˙co
2 slope values were lower in men and increased with age independent of sex. Fiftieth percentile values increased from 27.1 in the second decade to 33.9 in the eighth decade in men and from 28.5 in the second decade to 33.7 in the eighth decade in women. In the overall group, correlations with baseline characteristics and the V˙E/V˙co
2 slope were statistically significant (P < .05) although generally weak, particularly for age and body mass index.

Conclusion:

The results of the current study establish reference values for the V˙E/V˙co
2 slope when treadmill testing is performed, and all exercise data are used for the slope calculation. These results may prove useful in enhancing the interpretation of CPX results when assessing CRF.
Nonuniform Exposure to the Cornea from Millimeter Waves
Authors: Foster Kenneth R. , Laakso Ilkka , Chalfin Steven
Published: January 2021

This study examines the nonuniform exposure to the cornea from incident millimeter waves at 94-100 GHz. Two previous studies measured temperature increases in the rhesus cornea exposed to brief (1-6 s) pulses of high-fluence millimeter waves (94 GHz), one of which also estimated thresholds for corneal damage (reported as ED50, the dose resulting in a visible lesion 50% of the time). Both studies noted large variations in the temperature increase across the surface of the cornea due to wave interference effects. This study examines this variability using high-resolution simulations of mm-wave absorption and temperature increase in the human cornea from exposures to plane wave energy at 100 GHz. Calculations are based on an earlier study. The simulations show that the peak temperature increases in the cornea from short exposures (up to 10 s) to high-intensity mm-wave pulses are 1.7-2.8 times the median increase depending on the polarization of the incident energy. A simple one-dimensional “baseline” model provides a good estimate of the median temperature increase in the cornea. Two different estimates are presented for the thresholds for producing thermal lesions, expressed in terms of the minimum fluence of incident 100 GHz pulses. The first estimate is based on thresholds for thermal damage from pulsed infrared energy, and the second is based on a thermal damage model. The mm-wave pulses presently considered far exceed current IEEE or ICNIRP exposure limits but may be produced by some nonlethal weapons systems. Interference effects due to wave reflections from structures in and near the eye result in highly localized variations in energy absorbed in the cornea and surrounding facial tissues and are important to consider in a hazard analysis for exposures to intense pulsed millimeter waves.
Validation of a Dose Assessment Method to be Used in 18F FDG Loose Contamination Exercises
Authors: Chen Miles L. , Cochran Lainy D. , Marianno Craig M.
Published: January 2021

Radiological emergency response may require responders to operate in contaminated environments. To provide more realistic training to these individuals, it has been proposed to disperse low amounts of short-lived radioactive material in simulated emergency scenarios. To demonstrate the applicability and safety of such activities, a limited exercise was conducted where 18F was sprayed in a small area and survey activities were executed. A pre-job external radiation exposure dose assessment was performed in preparation for this training. The research presented here compares participant external recorded doses to assessment results in order to validate the dose estimates. Two individuals were used during the dispersion, search, and survey activities. First, a radiation worker mixed 200 MBq Fludeoxyglucose 18F with 470 mL H2O in a weed sprayer and distributed it over a 3 m × 3 m area. After evaporation, an exercise participant performed search and survey activities in the area. Actual whole-body doses measured with optically stimulated luminescence dosimeters were 10 ± 1 μSv for both personnel. Whole-body digital dosimeters read 4.3 ± 0.2 μSv and 3.3 ± 0.5 μSv for the radiation worker and exercise participant, respectively. Actual extremity doses were below the dosimeters’ minimum detectable limits for the radiation worker (thermoluminescence dosimeter) and exercise participant (optically stimulated luminescence dosimeter). The dose assessment-predicted whole-body doses were 2.8 ± 0.4 μSv and 3.2 ± 0.1 μSv for the radiation worker and exercise participant, respectively. The estimated dose to the radiation worker’s hand was 21.8 ± 3.8 μSv, and the estimated dose to the exercise participant’s knee was 13.4 ± 0.6 μSv. The study provided substantial evidence for the validity of the dose assessment method, supporting its use for a larger training exercise.
Comparison of Neutron Organ and Effective Dose Coefficients for PIMAL Stylized Phantoms in Bent Postures in Cranial and Caudal Irradiation Geometries
Authors: Sivabhaskar Sruthi , Perry Alexander , Dewji Shaheen
Published: January 2021

Radiation dose estimations in the human body are performed using computational reference phantoms, which are anatomical representations of the human body. In previous studies, dose reconstructions have been performed focusing primarily on phantoms in an upright posture, which limits the accuracy of the dose estimations for postures observed in realistic work settings. In this work, the International Commission on Radiological Protection (ICRP) Publication 103 recommendations for monoenergetic neutron plane sources directed downward from above the head (cranial) and upward from below the feet (caudal) for adult female and male reference phantoms were used to calculate organ absorbed and effective dose coefficients. The Phantom with Moving Arms and Legs (PIMAL) and the Monte Carlo N-Particle (MCNP) radiation transport code were used to compute organ-absorbed dose and effective dose coefficients for the upright, half-bent (45°), and full-bent (90°) phantom postures. The doses calculated for each of the articulated positions were compared to those calculated for the upright posture by computing the ratios of the coefficients (45°/upright and 90°/upright). These ratios were used to assess the effectiveness of upright phantoms in providing a comparable estimate when conducting dose estimations and dose reconstructions for articulated positions. This work compiling neutron cranial and caudal posture-specific dose coefficients completes the series of dose coefficients computed for posture-specific ICRP Publication 116 irradiation geometries for monoenergetic photons and neutrons, in addition to cranial and caudal monoenergetic photons. Results reported demonstrated that organ-absorbed dose coefficients for most of the organs in the CRA and CAU irradiation geometries were significantly higher for the bent phantoms than for the upright phantom. Since the upright phantom underestimates the organ-absorbed dose, this demonstrates the impact of posture while performing dose calculations. Organ doses reported in past neutron dose coefficient data were found to omit effects from neutron resonances at energies of 0.435, 1.0, and 3.21 MeV from 16O in tissue. Reported data notes as high as 60% underestimation for neutron organ-absorbed doses, specifically at the neutron resonance energy region omitted by smoothing. Ongoing studies are examining the effect of resonances on reported neutron organ-absorbed dose coefficients in ICRP 116 geometries.
Exposure to Radon and Progeny in a Tourist Cavern
Authors: Anderson Jeri L. , Zwack Leonard M. , Brueck Scott E.
Published: January 2021

The primary objective of this work was to characterize employee exposure to radon and progeny while performing guide/interpretation and concessions duties in a tourist cavern. Radon gas and progeny concentrations, fraction of unattached progeny, and other environmental parameters were evaluated in a popular tourist cavern in Southeastern New Mexico. Alpha-track detectors were used to measure radon gas in several cavern locations during a 9-mo period. Additionally, radon gas and attached and unattached fractions of radon progeny were measured at three primary cavern work locations during a 1-d period using a SARAD EQF 3220. Radon gas concentrations in the cavern were elevated due to extremely low air exchange rates with substantial seasonal variation. Mean measured radon concentrations ranged from 970 to 2,600 Bq m−3 in the main cavern and from 5,400 to 6,000 Bq m−3 in a smaller cave associated with the regional cave system. Measurements of unattached fractions (0.40-0.60) were higher than those commonly found in mines and other workplaces, leading to the potential for relatively high worker dose. Although radon gas concentrations were below the Occupational Safety and Health Administration Permissible Exposure Limit, employees working in the cavern have the potential to accrue ionizing radiation dose in excess of the annual effective dose limit recommended by the National Council on Radiation Protection and Measurements due to a high unattached fraction of radon progeny. There was a strong negative correlation between unattached fractions and equilibrium factors, but these parameters should be further evaluated for seasonal variation. Introduction of engineering controls such as ventilation could damage the cavern environment, so administrative controls, such as time management, are preferred to reduce employee dose.
Predisposing Factors, Clinical Presentations, and Outcomes of Contact Lens–Related Pythium Keratitis
Authors: Nonpassopon Manachai , Jongkhajornpong Passara , Aroonroch Rangsima , Koovisitsopit Atit , Lekhanont Kaevalin
Published: January 2021

Purpose:

To describe predisposing factors, clinical presentations, and treatment outcomes of contact lens (CL)–related Pythium keratitis.

Methods:

This was an 11-year retrospective study of CL-related Pythium keratitis conducted from 2009 to 2019. Six eyes of 6 patients were identified. Demographics, predisposing factors, CL history, clinical presentation, diagnostic tests, treatments, and outcomes were reviewed.

Results:

Mean age of the patients was 34 years (SD 16.3 years) with equal proportion between male and female patients. Five of 6 patients (83.3%) used soft CL, whereas 1 patient used rigid gas permeable lens. All patients had a history of water contamination (tap water and water from river and sea). Mean duration from the onset was 7.8 days (range 4–14 days). Mean size of the corneal lesion was 3.33 mm (SD 1.31 mm) in width. The typical feature of tentacle-like lesions radiating in a reticular pattern was observed in all patients. Feathery edge (1 eye), satellite lesions (2 eyes), and radial keratoneuritis (2 eyes) were also found. Every patient received therapeutic penetrating keratoplasty because of failed medical treatments. One patient subsequently underwent enucleation. Globe salvage was achieved in 5 patients (83.33%).

Conclusions:

Awareness of the history of water contamination, recognition of specific clinical features of Pythium keratitis, and performing surgical treatment are key for achieving globe salvage in patients with CL-related Pythium keratitis.
SARS-CoV-2 and Respiratory Syncytial Virus Coinfection in Hospitalized Pediatric Patients
Authors: Alvares Paula Andrade
Published: January 2021

In this study, children under 24 months of age hospitalized with respiratory compromise due to COVID-19 were retrospectively analyzed according to the event of coinfection with respiratory syncytial virus. Of 32 patients, 18.7% had coinfection and these had a significantly longer length of stay. There were no differences regarding need for intensive care, mechanical ventilation or mortality rates.
Pneumococcal Serotype-specific Opsonophagocytic Activity in Interleukin-1 Receptor-associated Kinase 4-deficient Patients
Authors: Uehara Tomoko , Morino Saeko , Oishi Kazunori , Nakamura Yukitsugu , Togashi Noriko , Imaizumi Masue , Nishimura Shiho , Okada Satoshi , Yara Asao , Fukushima Hiroko , Imagawa Kazuo , Takada Hidetoshi
Published: January 2021

Background:

The antibody response after pneumococcal vaccines and their effectiveness against invasive pneumococcal disease (IPD) in patients with interleukin-1 receptor-associated kinase 4 (IRAK4) deficiency have not been fully evaluated. Here, we evaluated pneumococcal serotype-specific opsonophagocytic activity (OPA) in IRAK4-deficient patients along with their clinical course.

Methods:

We investigated 6 IRAK4-deficient patients in Japan, whose attending physicians could be contacted. We performed OPA measurements using stored and more recent serum samples obtained from these patients.

Results:

All patients had received pneumococcal vaccination. Among the 3 patients who had IPD, 2 had an episode of pneumococcal meningitis and the other developed pneumococcal bacteremia 3 years after the occurrence of pneumococcal meningitis. Only one episode of invasive bacterial infection was caused by a Streptococcus pneumoniae vaccine-type strain. An increased opsonization index was found in the sera after vaccination for all IRAK-deficient patients, including when the 23-valent pneumococcal polysaccharide vaccine was used.

Conclusions:

A significant increase in levels of OPA against most of the pneumococcal vaccine antigens was observed for all IRAK4-deficient patients. However, IPD could not be prevented by pneumococcal vaccination alone. Therefore, adequate prophylaxis should be provided with antibiotics at least until 8 years of age, along with regular immunoglobulin therapy, particularly during the infantile period.
Gastrointestinal Zygomycosis in a Preterm Neonate Associated With Contaminated Probiotics
Authors: Bizzarro Matthew J. , Peaper David R. , Morotti Raffaella A. , Paci George , Rychalsky Michelle , Boyce John M.
Published: January 2021

A neonate of 29 weeks’ gestation who received probiotics developed clinical signs suggesting surgical necrotizing enterocolitis. A specimen of resected ileum revealed fungal forms within the bowel wall. Rhizopus oryzae was detected via DNA sequencing from probiotic powder and tissue specimens from the infant. To our knowledge, this is the first report linking gastrointestinal zygomycosis to the administration of contaminated probiotics.
Application of a Pneumococcal Serotype-specific Urinary Antigen Detection Test for Identification of Pediatric Pneumonia in Burkina Faso
Authors: Bountogo Mamadou , Sanogo Bintou , Pride Michael W. , Jiang Qin , Nikièma Zakari , Njanpop-Lafourcade Berthe-Marie , Ouédraogo Abdou Salam , van der Linden Mark P. G. , Moisi Jennifer , Tall Haoua , Essoh Alima , Betsem Edouard , Gessner Bradford D. , Meda Nicolas
Published: January 2021

Background:

Serotype-specific diagnosis of pneumococcal community-acquired pneumonia in children under age 5 years would mark a major advancement for understanding pneumococcal epidemiology and supporting vaccine decision-making.

Methods:

A Luminex technology-based multiplex urinary antigen detection (UAD) diagnostic assay was developed and subsequently validated in adults, but its applicability to children is unknown. This study aimed to set appropriate cutoffs for use of the UAD in a healthy pediatric population and apply these cutoffs in children with pneumonia in sub-Saharan Africa. The cutoffs were determined by assessing 379 urines obtained from healthy children under age 5 years from the Bobo-Dioulasso area for serotypes included in 13-valent pneumococcal conjugate vaccine (UAD-1) and the 11 other serotypes unique to 23-valent pneumococcal polysaccharide vaccine (UAD-2).

Results:

Based on the assigned cutoff values, among 108 children who met the World Health Organization consolidation endpoint criteria, UAD-1 and UAD-2 were positive in 23.3% and 8.3%, respectively; among 364 children with clinically suspected pneumonia who did not meet the World Health Organization criteria, UAD-1 and UAD-2 were positive for 6.6% and 3.6%, respectively. Pneumococcal carriage prevalence was similar among pneumonia cases (30%) versus controls (35%) as was semiquantitative carriage density.

Conclusions:

UAD-1 and UAD-2 were able to distinguish community controls from children with pneumonia, particularly pneumonia with consolidation. Future studies are needed to confirm these results and more fully assess the contribution of pneumococcal carriage and concurrent viral infection.
Multisystem Inflammatory Syndrome in an Adult With COVID-19
Authors: Brown Leah M. , Semler Matthew W. , Hansen Megan , Person Anna K. , Kelly Sean G.
Published: January 2021

Multisystem inflammatory syndrome (MIS) in children is a severe illness characterized by fever, laboratory evidence of inflammation, and multisystem organ dysfunction resulting from severe acute respiratory syndrome coronavirus 2 infection in a patient younger than 21 years. We present the case of a 39-year-old man with evidence of prior COVID-19 who seemed to meet all non–age-related criteria for MIS in children as well as criteria for the working definition of MIS in adults, and who improved after treatment with aspirin, corticosteroids, and intravenous immunoglobulin. Clinicians should be aware of this new inflammatory illness, not only in children but potentially also in adults with antecedent or concurrent COVID-19.
A Case Report of the Hospital-Acquired Coronavirus Disease 2019 Pneumonia
Authors: Adedeji Adekola , Riffle Lori , Charoenpong Prangthip , Mohammed Alam
Published: January 2021

This study presented a case of coronavirus disease 2019 pneumonia in a patient in isolation for 103 days. Severe acute respiratory syndrome coronavirus 2 was positive in her last 4 days. Despite policies of temperature checks for employees and visitors, and employees facing patients wearing a mask, the transmission of severe acute respiratory syndrome coronavirus 2 from an asymptomatic carrier was inevitable.
Risk Factors of Venoarterial Extracorporeal Membrane Oxygenation–Related Intracranial Hemorrhage in Children with Congenital Heart Disease
Authors: Yang Yinyu , Yu Xindi , Guo Zheng , Zhang Wei , Shen Jia , Wang Wei
Published: January 2021

To analyze the risk factors for intracranial hemorrhage (ICH) in congenital heart disease (CHD) patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). We performed a retrospective analysis of VA ECMO patients after open heart surgery in Shanghai Children’s Medical Center from February 2017 to December 2018, with a total of 50 patients: 14 patients in the ICH group and 36 patients in the control group. Clinical data were analyzed and compared between groups to search for risk factors for ICH. The overall incidence of ICH was 28% (14/50). The in-hospital mortality rate of the ICH group was 57.1% (8/14) vs. 58.3% (21/36) in the control group. The proportion of neonates in the ICH group was 64.3% (9/14) vs. 25% in the control group (9/36) (p = 0.009), and the ICH incidence in extracorporeal cardiopulmonary resuscitation (ECPR) patients was 64.3% (9/14) vs. 13.9% (5/36) (p = 0.000). The percentage of selective cerebral perfusion in the ICH group was 64.3% (9/14) vs. 16.7% (6/36) (p = 0.001) in the control group, and the maximum procalcitonin (PCT) was 43.70 ± 30.48 ng/ml in the ICH group versus 26.92 ± 23.28 ng/ml (p = 0.050) in the control group. Multivariate analysis showed that neonates (odds ratio [OR] = 6.47 [1.09–38.46]), ECPR use (OR = 7.48 [1.26–44.41]), and maximum PCT values (OR = 1.04 [1.001–1.070]) were independent risk factors for ICH. The probability of ICH remains high in children supported with VA-ECMO after cardiac surgery. Neonatal patients, ECPR use, and PCT peak values are independent risk factors for ICH.
“Compassionate” Cases of the Jarvik 2015 Ventricular Assist Device
Authors: Spinner Joseph A. , Tunuguntla Hari P. , Tume Sebastian C. , Elias Barbara A. , Mcmullen Jason , John Rija , Choudhry Swati , Price Jack F. , Denfield Susan W. , Dreyer William J. , Adachi Iki
Published: January 2021

The Jarvik 2015 Ventricular Assist Device (VAD) (Jarvik Inc, New York, NY) is the first and currently only continuous-flow VAD specifically designed for small children, and it is being evaluated in the so-called Pump for Kids, Infants, and Neonates (PumpKIN) trial. Due to the strict inclusion criteria of the trial, there have been a group of patients who failed to meet the criteria and therefore received the Jarvik 2015 VAD under the designation of “compassionate use.” This is the same phenomenon seen previously during the Berlin Heart EXCOR trial. While we await the results of the PumpKIN trial, which will report the device performance in a strictly selected population, the compassionate use cases represent actual “real world” experiences. We describe herein our experience of two compassionate use cases. In particular, this report has a special emphasis on the power consumption and hemolysis and inflammatory lab profile of the Jarvik 2015 VAD as hemocompatibility was the primary focus of the developmental and the preclinical phases.
Can Patients Be Transplanted or Undergo Ventricular Assist Device Placement During the COVID-19 Pandemic? Padova Perspective
Authors: Bagozzi Lorenzo , Bottio Tomaso , Tarzia Vincenzo , D’Onofrio Augusto , Gambino Antonio , Bianco Roberto , Toscano Giuseppe , Gerosa Gino
Published: January 2021

The SARS-CoV-2 pandemic is nowadays an international emergency and the North-Italian regions have faced a high rate of infection and case fatality. A logistic and structural rearrangement has been required to ensure COVID-19-free areas, to save human and economic resources, and to solve all incoming urgencies. Herein, we report the Padova experience in heart transplantation and mechanical circulatory support implantation for severe INTERMACS class patients with satisfactory results during COVID-19 pandemic.
Defining the nocturnal period in 24-h ambulatory blood pressure monitoring: a comparison of three methods
Authors: Slusniene Anzela , Navickas Petras , Stankus Albinas , Lauceviciene Ieva , Ryliskyte Ligita , Laucevicius Aleksandras
Published: January 2021

Objectives

The purpose of our study was to compare three definitions of ambulatory blood pressure (BP) nocturnal period and to assess their agreement in determining nocturnal BP dipping patterns.

Methods

We investigated 69 subjects with metabolic syndrome, aged 50–55 years. In all subjects, we assessed 24-h BP monitoring, electrocardiogram and actigraphy profiles. The nocturnal period was defined in three ways: as a fixed narrow nighttime period from 01:00 to 06:00, as a self-reported sleeping period and as a disappearance and onset of physical activity recorded by the actigraph.

Results

Our study revealed a significant discrepancy between the self-reported and actigraphy-based nocturnal periods (P < 0.001). In addition, different definitions of the nighttime yielded significant differences in determining nondipping, extreme dipping and dipping BP patterns, the identification of the latter being affected the most. The actigraphy-based approach best aligned with the fixed-time determination of the nocturnal period: Cohen’s kappa coefficient for the nondipping pattern was 0.78 (0.58–1), for the dipping pattern 0.75 (0.59–0.91) and for the extreme dipping pattern 0.81 (0.65–0.97). In comparison to the self-reported determination of the nocturnal period, using the actigraphy-based approach resulted in reclassifying the nocturnal BP pattern in 20.3% of subjects.

Conclusions

The lack of agreement between fixed-time, self-reported and actigraphy-based determinations of the nighttime period affects the identification of the nocturnal BP patterns. In comparison to the self-reported nocturnal period estimation, the actigraphy-based approach results in the reclassification of BP dipping status in every fifth subject.
Comparison of a tonometric with an oscillometric blood pressure monitoring device over 24 hours of ambulatory use
Authors: Miranda Hurtado Martin , Reyes Vasquez Javiera , Rodriguez-Fernandez Maria
Published: January 2021

Purpose

Multiple devices capable of measuring ambulatory blood pressure without cuffs have been recently developed and it is required that they offer high-accuracy measurements. The purpose of this prospective study was to compare the performance of a tonometric blood pressure monitor with that of an oscillometric cuff-based device used as a reference in healthy and hypertensive subjects over 24 hours of ambulatory use.

Materials and methods

Conventional oscillometric cuff-based device (Oscar 2; Sun Tech Medical) was placed in the left arm of 33 subjects, and a watch-type device based on the tonometric method (Bpro; HealthSTATS International, Singapore) was positioned in the right wrist. Both devices were synchronized to measure simultaneously over 24 hours.

Results

The difference between the means over 24 hours of the oscillometric and the tonometric devices was −0.9 mmHg for SBP and −4.5 mmHg for DBP; the standard deviations were 14.7 and 12.2 mmHg, respectively. Greater differences in bias and dispersion were observed overnight than during the daytime. The accuracy of the tonometric device for diagnosing hypertension was 75% and for detecting the non-dipper profile, 48%.

Conclusion

The test device presented a high disagreement (especially during the night) compared to the oscillometric cuff-based device against which it was initially calibrated. This disagreement resulted in limited accuracy for diagnosing patients with suspected arterial hypertension and detecting non-dipper profiles.
Coronavirus and Nutrition
Authors: Naidu A. Satyanarayan , Pressman Peter , Clemens Roger A.
Published: January 2021

In the wake of the COVID-19 pandemic, global medical research has undertaken a relentless quest to unravel the virulence mechanisms of SARS-CoV-2, the innate barriers of host defense, the surveillance of progress toward herd immunity, and the attempts to quickly identify and evaluate novel or alternative coronavirus interventions. This nutrition update highlights the important role of dietary factors in achieving optimum health and also explores possible approaches to augmenting innate host defenses. The potential anti-coronavirus benefits of micronutrients and macronutrients (ie, minerals, vitamins, lipids, proteins and polyphenols) to combat COVID-19 infection through inhibition of viral targets on human cell surface (ie, angiotensin-converting enzyme 2) for docking, entry, and replication and, furthermore, to regulate immune and inflammatory responses (cytokine storm), oxidative stress (redox imbalance), and normal signaling pathways to the reduce health risks among vulnerable populations (ie, elderly) with metabolic disorders (ie, obesity, diabetes, cardiovascular disease, hypertension, asthma) and recovery of patients to normal health are discussed.
Identification of an Infected Urachal Cyst Using Point-of-Care Ultrasound
Authors: Austin Samuel , Jersey Candice , Soltis Michael , Chicaiza Henry
Published: January 2021

This case describes a 6-year-old girl who presented to the pediatric emergency department with 3 days of fever and suprapubic pain in the setting of 1 month of worsening, dull abdominal pain. On presentation, she had a tender, erythematous, and fluctuant mass on her lower abdomen. Point-of-care ultrasound was used to identify an abnormal fluid collection anterior to her bladder, suspicious for an infected urachal cyst. In this case, point-of-care ultrasound helped identify this uncommon finding in a timely fashion, which expedited definitive care and prevented unnecessary exposure to ionizing radiation.
Local Treatment of Triple-Negative Breast Cancer
Authors: Machiels Melanie , Kaidar-Person Orit , Rubio Isabel T. , Poortmans Philip
Published: January 2021

Triple-negative breast cancer, compared with other molecular subtypes, poses particular challenges for optimizing the timing and the extent of locoregional treatments. In the past, the combination of increased rates of both locoregional and distant recurrences led to a preference of radical surgery and extensive radiation therapy; however, since the introduction of more effective chemotherapy, a sharp de-escalation in the extent of locoregional treatments followed. Current evidence confirms that less aggressive surgery in combination with tailored radiation therapy offers improved oncological outcomes combined with better quality of life. However, further research is required to optimize locoregional treatments, considering the significant heterogeneity in biological behavior and tumor response to systemic treatments.
Ultrasound Evaluation of the Axilla in the Breast Imaging Setting
Authors: Teichgraeber Davis C. , Perez Frances , Guirguis Mary S. , Kapoor Megha M. , Whitman Gary J.
Published: January 2021

Ultrasound evaluation of the axilla plays a critical role in the setting of newly diagnosed breast cancer as surgical management evolves toward more targeted axillary nodal resection. Regional nodal involvement by metastatic carcinoma is one of most important prognostic factors in breast cancer and guides local, regional, and systemic treatment. Ultrasound also evaluates response to neoadjuvant chemotherapy. This article will review ultrasound techniques and the anatomy and the morphology of axillary lymph nodes. Lymph node staging in breast cancer will also be discussed. Ultrasound-guided interventions and localizations and emerging technologies of elastography and contrast-enhanced ultrasound will be discussed. In addition, this article will discuss the role of ultrasound as it applies to management of the axilla since the American College of Surgeons Oncology Group Z011 and Z1071 trials. Finally, other causes of benign and malignant axillary lymphadenopathy, not related to breast cancer, are discussed.