bluuebunny/crossref_metadata_2025 huggingface dataset:
717 Critically injured patients receiving kefir may have lower rates of Clostridium difficile
Authors: Lillie Andrea , Nordlund Megan , Stewart Barclay T , Gause Emma L
Published: March 2022

Introduction

Kefir is an easy to administer per feeding tube probiotic yogurt that does not contain the risk of powdered probiotics, which may contaminate patient wounds or intravenous lines. Previous studies show patients taking probiotics may decrease hospital-acquired infections (HAI) although kefir has not been well studied. We hypothesized that kefir would be well tolerated and prevent infections among critically injured patients including patients with burn injury on enteral nutrition (EN).

Methods

We performed a retrospective review of adult critically injured patients at a level 1 trauma and burn center from January 2018 to March 2021 who received EN. Patients with a history of clostridium difficile (C. diff) were excluded. Patients who received kefir were given 120ml twice daily. The kefir protocol was improved with input from clinical stakeholders. The rate of C. diff, catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infection (CLABSI) were compared between patients who received kefir and those who did not. Incidence rate ratios (IRR) and corresponding 95% confidence intervals were calculated to assess differences in these rates.

Results

3,814 patients met criteria, 545 of whom received kefir (14%). Suggested improvements to the kefir protocol by stakeholders were changing flavored to plain kefir to decrease the amount of carbohydrate, change to lactose-free kefir to improve usage in lactose intolerant patients, and educate nurses on flushing feeding tubes to avoid clogs.

None of the incidence rates of HAI were significantly different between patients who received kefir and those who did not (Table 1). Crude IRRs suggest that C. diff infections may have occurred less frequently among patients who received kefir while the reverse occurred for CLABSI infections, though these results are not significant.

Conclusions

The kefir implementation was refined by stakeholder feedback. Although no clear benefit of kefir was observed with HAI reduction, future research should investigate the potential association between kefir use and C. diff.
729 "Feets" of Strength: How Glabrous Skin Defied the Odds
Authors: Gernt Megan , O'Rourke Cassandra
Published: March 2022

Introduction

58 year old female with past medical history notable for IDDM with peripheral neuropathy presented to ER after stepping barefoot onto asphalt in August 2020. Patient initially presented to community ER who performed bedside debridement and referred patient to wound clinic for management. After presenting to wound clinic, patient was referred to Burn center. She arrived 10 days after burn and was found to have full thickness burns to the soles of bilateral feet, 3% TBSA. The majority of the soles of both feet were injured. The patient had little residual glabrous skin which was uninjured. Glabrous skin is highly specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes.

Methods

The patient was extremely compliant and willing to do whatever was necessary to maintain function. The patient underwent one debridement, two debridements with allografting, and one debridement with wound vacuum application. Wounds were initially treated with daily silvadene dressings and transitioned to daily damp to dry and finally to daily xeroform dressings. Wounds were measured at each follow up appointment, plan was made to intervene only when wounds stopped showing progress, however this plateau was never reached, and wounds were allowed to heal without any further intervention.

Results

One year post burn, the right sole is fully healed while the left sole remains with small open area. The patient does have significant alterations to her gait pattern. However, the patient has managed to heal her wounds and is functioning independently.

Conclusions

Given patient’s IDDM, her perceived chances of healing a graft was low. Furthermore, her risk of infection and eventual amputation was high. Given a very compliant patient and diligent wound care, the patient was able to achieve significant healing of wounds without the need for amputation. Glabrous skin is specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes. Allowing the patient’s own glabrous skin to pull across the bed and heal has provided for optimal functional outcomes.
738 Does A History of Malignancy Lead to Worse Outcomes in Burns?
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia
Published: March 2022

Introduction

A history of malignancy is associated with worse outcomes in cardiac disease and trauma. Our objective was to determine if a past medical history of cancer portends increased morbidity or mortality in burns or skin-sloughing disorders.

Methods

Patients were identified using our institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted between January 1, 2014 and June 30, 2021 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results

A total of 8,018 patients were admitted during this period, and of those patients, 436 had a history of cancer (5%). Patients with a history of cancer were older (56 years versus 44 years), p< 0.0001. They had a significantly longer LOS. They had larger burns and higher hospital costs. They were more likely to be female and more likely to have a skin-sloughing disorder. Patients with a history of cancer also had higher mortality rates.

Conclusions

A history of cancer is associated with worse outcomes in patients admitted for burn injury or skin-sloughing disorders. Further study is warranted to investigate and mitigate what aspect of their care could be adjusted to improve outcomes.
748 Burn Center Family Needs Study Brings Changes to The Unit Practice
Authors: Hsu Naiwei , Fox Jasmine
Published: March 2022

Introduction

Pediatric burn patient family needs have many similarities to adult burn patients. However, based on our abstract Family Needs of Adult & Pediatric Burn Patients study from 2013 to 2018, there is a difference. We found our desire to preserve the pediatric burn patient family members as the "safe, comforting person" prevented them from learning all the necessary skills to be the successful caregivers once the child was discharged.

Methods

An integrative review is conducted using a literature search from EBSCOhost, CINAHL, Scopus, Medline, and PubMed. We found very little information addressing this specific concern for our pediatric burn population. However, there is a lot of literature discussing how to involve pediatric family members with other childhood diseases and the benefits of making pediatric family members a part of the treatment team. We shared our literature findings along with the results of responses we got from our Family Needs of Adult & Pediatric Burn Patients study with our Shared Decision-Making (SDM) Council and implemented our new practice.

Results

An informal interview results showed much improved pediatric burn family member satisfaction. By the time the family takes the burn child home, they demonstrate proficient dressing change skills along with the knowledge of how to manage their pain, itch, nutritional needs, and how to contact their care team as needed.

Conclusions

While most of us know the importance of family centered care, putting this concept into practice need more structured approaches and administrative support. Unit based SDM Council and Journal Club can help to keep our nursing staff, especially the new hires to embrace this practice.
760 Wholistic View of Autografting Patients by %TBSA Burned: Medical Chart Abstraction Integrated with Administrative Claims
Authors: Hahn Helen D , Yu Tzy-Chyi , Teng Chia-Chen , Tan Hiangkiat
Published: March 2022

Introduction

The current literature of severe burns with autografting is scarce or limited to single data source. This study provides a wholistic view of the clinical and economic characteristics of the inpatient treatment of patients with burns using integrated medical chart abstraction with administrative claims.

Methods

Patients with thermal burns undergoing inpatient autografting between July 1, 2010 and November 30, 2019 were identified from large national health plans, representing over 50 million members in the US. The first observed hospitalization with autografting was regarded as the index event. Two hundred hospital patient medical records were abstracted for the clinical characteristics, using a standardized abstraction form, which were integrated with administrative data for economic characteristics. Those with large % TBSA were oversampled. Patients were stratified into three cohorts by %TBSA burned. A Bonferroni correction of alpha 0.017 was performed for post-hoc pairwise tests.

Results

Of 200 patients, 90 were categorized as low TBSA (< 10%), 75 moderate TBSA (10 – 24%), and 35 high TBSA (25+%). Overall, the high %TBSA cohort appeared to be younger, requiring more intensive care, and thereby incurring higher costs of care. The extent of some undocumented critical fields in the medical records was significant, for example (%undocumented): donor size (80%), BMI (31%), mesh ratio (30%), etc.

1 mean (SD)

* compared with low TBSA, p< 0.017

Conclusions

This study not only confirmed some conventional understanding of various TBSA cohorts, but also quantified their differences/similarities using multiple data sources. There was considerable incompleteness in many critical fields in the medical records, which limits the ability to generate broader insights. Despite the wide regard of medical records as a “gold standard” for outcomes analyses, future research should be aware of these limitations.
769 The association of a burn injury with social engagement: A Preschool-LIBRE1-5 study
Authors: Baird Maree , Skipton Romanowski Kathleen S , Ni Pengsheng , Patel Khushbu F , Kazis Lewis E , Ryan Colleen M , Palmieri Tina L
Published: March 2022

Introduction

Social engagement, primarily through peer interactions, is an active-coping strategy that is key to community re-integration after a burn injury. For young children, social engagement encourages standard development, with burn injuries potentially affecting their likelihood to engage with others. We utilized the parent-report Preschool-LIBRE1-5 (Life Impact Burn Recovery Evaluation) to explore factors that can influence a child’s social engagement.

Methods

Our participants were 426 parents of burned children ages one through five who completed the Preschool-LIBRE1-5. Four variables involving social engagement were assessed: “frequency of child avoiding other children,” “frequency of child playing alone,” “frequency of child wanting to be left alone,” and “frequency of child liking to be around other children.” Responses from a 5-point Likert scale ranging from never to always were recoded on a 3-point Likert scale such that a higher score indicated increased social engagement. A nominal logistic regression analysis was conducted with each social engagement variable as a separate dependent variable for each model. The age of the patient when the survey was completed and gender were independent variables. The models also were adjusted by the presence of a hand burn, a face burn, burn size, race, and ethnicity. A bootstrap analysis was conducted to assess internal validity of the significant findings.

Results

The sample characteristics included: mean age of 3.1+1.4 years, mean time since burn injury of 1.2+1.3 years, mean total body surface area (TBSA) of 4.2+7.9, 55.2% male, and 74.2% white. Findings did not reach significance for three of the dependent variables. However, the dependent variable “frequency of child liking to be around other people” was significant with an increased odds of 35.8% for older children compared to younger ones. (OR [95% CI] =1.358 [1.027, 1.795]). Further, boys were much less likely to want to be left alone (OR [95% CI] = 2.97[1.36,6.5]). Among 500 bootstrap samples, 59% and 79% of the samples replicated the significant findings respectively.

Conclusions

In preschool children with burn injuries, burn location, race, and ethnicity were not associated with the social engagement items tested in this study. Boys did show a higher likelihood of peer engagement suggesting that gender may influence a child’s desire to be alone.
771 Improving Burn Care in the Amish Community: A Qualitative Study of Strengths and Needs
Authors: Brumbaugh Jamey T , Kelleher Jennifer A , Snider Mira , Sturges Mariah , Aballay Ariel M , Duncan Christina L
Published: March 2022

Introduction

Amish communities present with a higher risk for sustaining traumatic burn injuries; thus, these communities have a high need for culturally competent burn care. Although homeopathic remedies for mild to moderate burn injuries have been studied in Amish communities, little is known about hospital-community partnerships to facilitate culturally competent burn care, particularly with more severe injuries. The current study aimed to 1) understand the successful aspects of an existing hospital-community partnership for facilitating culturally sensitive burn care for Amish communities, and (2) identify the ongoing physical, structural, and behavioral health needs of this population as the partnership continues to develop.

Methods

Qualitative data from 12 Amish caregivers who participate on a burn/wound team or an oil therapy team, were collected on through a focus group interview. Caregivers identified as White, were majority male (83%), and resided in Amish communities. Retrospective thematic analysis was used to analyze the qualitative data. Five major themes (i.e., informational needs, strengths of Amish burn care, behavioral health concerns, behavioral health resources, and preferred teaching methods) evolved.

Results

Results indicated that Amish caregivers displayed a great curiosity and openness to learning about all aspects of recommended burn care from the medical providers. Caregivers also cited their traditional (homeopathic) burn care procedures (e.g., oil therapy) as strengths, while simultaneously maintaining that their relationship to the hospital is a valuable part of their burn care. Relating to behavioral health, caregivers highlighted difficulties in helping their children cope with burn injuries and pain during rehabilitation and treatment. Caregivers emphasized the role of strong social support that the Amish community provides to burn survivors. Additionally, caregivers stressed the significance of delivering burn care information in a form that is culturally appropriate for their community.

Conclusions

Results of this study provide important considerations that other accredited burn centers may consider when establishing similar partnerships to enhance their delivery of culturally competent medicine for Amish burn survivors.
780 Quality Improvement of the Road Rash Patient
Authors: Sturges Mariah , Bregg Jason M
Published: March 2022

Introduction

What is road rash? “Road rash is a unique burn injury due to imbedded foreign debris and deeply seeded bacteria. Literature on this injury fails to address its unique mechanism and ways to reduce scarring and infection.” (Collier 2020) In the study they found that road rash was not an easy subject to find information on. They did a systematic study to see what information was readily available on road rash. They found that only 24 pertinent articles were found.

Our policies and procedures are based on that of the American Burn Association within the Burn Center. When creating the Road Rash protocol. Use used the same transfer criteria that the American Burn Association identifies. As for the trauma aspect we have covered by ensuring that the trauma is ruled out by a hospital in our network before coming to our center to treat the wound.

Methods

We began to notice that most of the road rash patients that were transferred to us, had not gotten proper care in the outside hospital. The situation would be a patient who should have been directly transferred to us, came to the outpatient clinic where we then would have to perform a very painful dressing change that would have been avoided with the proper methods of transfer and education. We first gathered the data of the transfers that had not gone correctly.

The data that we are looking at for our road rash patients are as follows; TBSA , depth of injury. Location of injury, age, socioeconomic status, type of dressing used, and photos taken before transfer.

We had used data from the year 2019- March of 2021. Total amount was 5 patients. Of these patients 0/5 had proper dressings. correct TBSA, or were transferred properly.

We then gathered our information and spent time hitting our trauma centers within our network. We gave presentations to the emergency department members.

From there we created a list for when we saw the patients in our inpatient unit or our clinic. We wanted to look at the care done before coming to the burn center and what we actually did at the burn center. We looked at TBSA, Location of injury, Age, type of dressing and if there were photos taken

Results

The resulted we wanted to show us if our teaching at these hospitals were effective. Of the 12 patients seen all the patients had the correct dressings on for the time of follow-up, 7/12 had pictures taken for the EMR. All 12 also had the right criteria for transfer or to follow-up in the clinic. The last result of the TBSA was not done correctly on all 12 of the patients.

Conclusions

In conclusion, This project had positive results in the fact that the teach was affective for the dressing changes and taking pre admission photos. We even saw an increase in the number of road rash patients we treated from 2019-2021. The negative results being the improper calculation of TBSA. This showed us where we need to adjust for the next presentations.
Fine-tuning the Ex Ante Approach to Regulating Data Combination Practices
Authors: Yan Xingyu , He Huaiwen
Published: March 2022

Antitrust in digital markets is gravitating towards ex ante regulation. This is prompted by growing concerns for user data exploitation and rival foreclosure on the part of big tech platforms. One particular area embodying such concerns pertains to data combination practices—more specifically, within-conglomerate data sharing, where data collection is scaled up in digital ecosystems and monetized through avenues such as attention brokerage. A recent effort to address such concerns is Article 5(a) of the Digital Markets Act proposal, which imposes a proscriptive obligation on gatekeeper platforms. This article rationalizes this ex ante approach to tackling exploitative data combination and highlights the need for further ex ante competition-enhancing measures that deal with the markets dominated by gatekeepers. Two directions are worth exploring: ecosystems compatibility and data as labour. Both underscore the importance of end users’ right to data portability.
Superior mesenteric artery thrombosis in a patient with COVID-19 pneumonia and Clostridium Difficle
Authors: Maniar Yesha , Hashmi Hassan , Silverstein Jeffrey , Chung Christine , Kella Venkata , Goparaju Anirudha
Published: March 2022

COVID-19, a novel respiratory viral illness, has spread globally and led to over 111 million cases worldwide. Most commonly, patients present with respiratory symptoms, and those with increased severity progress to acute hypoxic respiratory failure. Additionally, a portion of patients are noted to have coagulopathy and are considered to be at an increased risk for thromboembolic events. In this article, we present a unique case of a patient with severe abdominal pain in the setting of COVID-19 pneumonia and community acquired Clostridium difficile, found to have superior mesenteric artery thrombosis requiring exploratory laparotomy, thrombectomy and small bowel resection.
Infected mediastinal cysts following endobronchial ultrasound guided biopsy—a case series
Authors: Mohamed Saifullah , Patel Akshay J , Mehdi Rana , Menon Ashvini , Steyn Richard , Bishay Ehab
Published: March 2022

Mediastinal cysts are commonly an incidental finding simulating a benign or malignant diagnosis. Infection is a recognised complication of mediastinal cyst and therefore early surgical management is essential. Endobronchial ultrasound guided biopsy (EBUS) has been used to diagnose and manage mediastinal cyst. We present a case series of three patients who presented with sepsis following diagnostic EBUS of mediastinal cyst. We would recommend that EBUS guided biopsy be applied cautiously if there is a high suspicion of mediastinal cyst to avoid post procedural infection, which can thus complicate any future therapeutic options.
Pretreatment Human Immunodeficiency Virus (HIV) Drug Resistance Among Treatment-Naive Infants Newly Diagnosed With HIV in 2016 in Namibia: Results of a Nationally Representative Study
Authors: Jordan Michael R , Bikinesi Leonard , Ashipala Laimi , Mutenda Nicholus , Brantuo Mary , Hunt Gillian , Shiningavamwe Andreas , Mutandi Gram , Beukes Anita , Beard Suzanne , Battey Katherine , Dziuban Eric J , Raizes Elliot , Adjei Paul , Tang Alice , Giron Amalia , Hong Steven Y
Published: March 2022

Background

The World Health Organization (WHO) recommends routine surveillance of pretreatment human immunodeficiency virus (HIV) drug resistance (HIVDR) in children <18 months of age diagnosed with HIV through early infant diagnosis (EID). In 2016, 262 children <18 months of age were diagnosed with HIV in Namibia through EID. Levels of HIVDR in this population are unknown.

Methods

In 2016, Namibia surveyed pretreatment HIVDR among children aged <18 months following WHO guidance. Reverse transcriptase, protease, and integrase regions of HIV-1 were genotyped from remnant dried blood spot specimens from all infants diagnosed with HIV in Namibia in 2016. HIVDR was predicted using the Stanford HIVdb algorithm.

Results

Of 262 specimens genotyped, 198 HIV-1 protease and reverse transcriptase sequences and 118 HIV-1 integrase sequences were successfully amplified and analyzed. The prevalence of efavirenz/nevirapine (EFV/NVP), abacavir (ABC), zidovudine, lamivudine/emtricitabine (3TC/FTC), and tenofovir (TDF) resistance was 62.6%, 17.7%, 5.6%, 15.7%, and 10.1%, respectively. No integrase inhibitor resistance was detected.

Conclusions

The high level of EFV/NVP resistance is unsurprising; however, levels of ABC and TDF resistance are among the highest observed to date in infants in sub-Saharan Africa. The absence of resistance to dolutegravir (DTG) is reassuring but underscores the need to further study the impact of ABC and 3TC/FTC resistance on pediatric protease inhibitor– and DTG-based regimens and accelerate access to other antiretroviral drugs. Results underscore the need for antiretroviral therapy optimization and prompt management of high viral loads in infants and pregnant and breastfeeding women.
Liquidity Risk and Funding Cost
Authors: Bechtel Alexander , Ranaldo Angelo , Wrampelmeyer Jan
Published: March 2022

We propose and test a new channel that links liquidity risk and interest rates in short-term funding markets. Unlike existing theories that focus on premiums demanded by lenders, the liquidity risk channel postulates that borrowers that are more exposed to urgent liquidity needs are willing to pay a markup for immediate funding. We test and quantify the channel using unique trade-by-trade data and uncover systematic differences across individual banks’ funding cost driven by differences in banks’ liquidity risk. These differences are persistent over a decade, suggesting that the liquidity risk channel is relevant in general and not only arises during crisis times.
Giants on Clay Feet—COVID-19, infection control and public health laboratory networks in England, the USA and (West-)Germany (1945–2020)
Authors: Kirchhelle Claas
Published: March 2022

In early 2020, COVID-19 exposed differences in public health laboratory systems’ testing abilities. Focusing on Germany, the USA and the UK between 1900 and 2020, this article argues that studying the distinct evolution of laboratory infrastructures is critical to understanding the history of infection control and the limits of template-based reforms in global health. While each analysed laboratory infrastructure was shaped by a unique national context, neoliberal visions of lean public services and declining resources led to significant reform pressure from the 1970s. The US Center of Disease Control’s model of epidemic intelligence provided an attractive template to integrate resources and focus planning on preparedness scenarios. It also helped justify cuts to local laboratory infrastructures. Effects were uneven: in the USA and the UK, improved integration failed to compensate for local laboratory cuts and loss of autonomy. By contrast, Germany’s subsidiary principle allowed for limited federal integration while leaving local services mostly intact.
Plant-Microbiota Interactions in Abiotic Stress Environments
Authors: Omae Natsuki , Tsuda Kenichi
Published: March 2022

Abiotic stress adversely affects cellular homeostasis and ultimately impairs plant growth, posing a serious threat to agriculture. Climate change modeling predicts increasing occurrences of abiotic stresses such as drought and extreme temperature, resulting in decreasing the yields of major crops such as rice, wheat, and maize, which endangers food security for human populations. Plants are associated with diverse and taxonomically structured microbial communities that are called the plant microbiota. Plant microbiota often assist plant growth and abiotic stress tolerance by providing water and nutrients to plants and modulating plant metabolism and physiology and, thus, offer the potential to increase crop production under abiotic stress. In this review, we summarize recent progress on how abiotic stress affects plants, microbiota, plant-microbe interactions, and microbe-microbe interactions, and how microbes affect plant metabolism and physiology under abiotic stress conditions, with a focus on drought, salt, and temperature stress. We also discuss important steps to utilize plant microbiota in agriculture under abiotic stress.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Fractional CO2 Laser-Assisted Delivery Versus Intralesional Injection of Methotrexate in Psoriatic Nails
Authors: Alakad Rania , Nassar Amany , Atef Hadeel , Eldeeb Fatma
Published: March 2022

BACKGROUND

Nail psoriasis has a major negative impact on physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of difficult penetration of the drug into the nail.

OBJECTIVE

To evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis.

MATERIALS AND METHODS

Twenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The improvement of nail psoriasis was assessed by clinical and dermoscopic evaluation.

RESULTS

At the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p = .18), matrix score (p = .38), bed score (p = .23), and dermoscopic score (p = .78). However, the pain and subungual hematoma were significantly less in the laser group (p < .001 and p = .03, respectively).

CONCLUSION

Fractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.
Tranexamic Acid Microinjection Alone Versus Its Combination With Fractional Carbon Dioxide Laser in Melasma Treatment: A Dermoscopic Evaluation
Authors: Tawfic Shereen O. , Abdel Hay Rania M. , Abouelazm Dina I. , Said Eman R.
Published: March 2022

BACKGROUND

Melasma is a challenging pigmentation disorder.

OBJECTIVE

To assess and compare the efficacy of tranexamic acid (TXA) intradermal microinjection alone versus its combination with low-power, low-density fractional CO2 laser in a sequential pattern in melasma.

Patients and Methods

This study included 29 patients with melasma. Half of the face was randomly assigned to fractional CO2 laser; the other half to TXA. This split-face session was repeated every 6 weeks for 3 sessions. In between, TXA was applied to the full face every 2 weeks. Treatment duration was 4 months. Dermoscopy, melanin index (M.I), and erythema index (E.I) were evaluated at baseline and 4 weeks after the last session.

RESULTS

Melanin index, E.I, total dermoscopic score and different dermoscopic patterns of pigmentation, and vascular features showed significant reduction posttreatment on both sides of the face. No statistically significant difference was found regarding the degree and percentage of improvement in M.I, E.I, and total dermoscopic score between both sides.

CONCLUSION

Tranexamic acid microinjection alone or combined with low-power, low-density fractional CO2 laser in a sequential pattern are comparatively effective and safe for melasma treatment; however, combined treatment is recommended. Dermoscopy is an essential noninvasive tool in the assessment of melasma and monitoring patients' response to treatment.
Evaluation of the Demographic and Clinical Features of Patients With Digital Myxoid Pseudocysts and Their Response to Treatment
Authors: Güldiken Gaye , Göktay Fatih , Atış Güldehan , Güneş Pembegül
Published: March 2022

BACKGROUND

Digital myxoid pseudocysts (DMPs) are the most common benign degenerative lesions of the nail unit. There is currently no consensus regarding first-line treatments for DMPs.

OBJECTIVE

To evaluate demographic and clinical features and treatment methods of DMP and examine recurrence rates and factors that may affect recurrence.

METHODS AND MATERIALS

All patients in the authors' clinic who were diagnosed with DMP between 2013 and 2020 were included. Treatment methods were categorized as surgical excision (SE), drainage and compression (DC), simple drainage (SD), and no treatment. Responses and recurrence rates after different treatment methods were investigated.

RESULTS

Fifty-one lesions from 48 patients were included. Thirty-two lesions were treated with SE, 11 with DC, and 1 with SD, while 7 lesions were left untreated. The initial complete response rate after SE was significantly higher than that after DC. No statistically significant difference was found between the recurrence rates of the 2 treatment methods. Using intra-articular methylene blue during SE did not seem to affect recurrence rates.

CONCLUSION

Drainage and compression seems to be a safe and effective first-line treatment option for DMPs located on the proximal nail fold and distal interphalangeal joint. SE is more favorable as a second-line treatment.
PERIPHERAL CHOROIDAL THICKNESS DETERMINED BY WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY IN EYES WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: Nishihara Soichiro , Maruko Ichiro , Izumi Takahiko , Kawano Taizo , Iida Tomohiro
Published: March 2022

Purpose:

To determine the central and peripheral choroidal thickness in eyes with central serous chorioretinopathy (CSC) and to compare these thicknesses values with those of control normal eyes.

Methods:

Wide-field optical coherence tomographic images of 24 eyes of 19 patients with CSC and 14 normal eyes of 7 individuals were recorded. A 20-mm vertical scan through the fovea was obtained with the Xephilio optical coherence tomographic S1 (Canon, Japan), a wide-field optical coherence tomographic device. The subfoveal choroidal thickness and the thickness at 5 mm superior (S5) and inferior (I5), 7 mm superior (S7) and inferior (I7), 8.5 mm superior (S8) and inferior (I8), and 10 mm superior (S10) and inferior (I10) from the fovea in the CSC eyes and normal eyes were compared.

Results:

There was no significant difference in the age (P = 0.8) or the refractive error (P = 0.7) between the CSC and normal eyes. The choroidal thickness was significantly thicker in the eyes with CSC than that in the normal eyes at subfoveal choroidal thickness (P < 0.01), S5 (P = 0.01), and S7 (P = 0.02). However, there was no significant difference in the choroidal thickness at the more peripheral points (all P > 0.1).

Conclusion:

The thickened choroid in CSC was observed at the fovea and the area just superior to the fovea. The pathogenesis of CSC may be associated with the choroidal thickening confined to the fovea and superior foveal area.
COMPARISON OF SURGEON MUSCULAR PROPERTIES BETWEEN STANDARD OPERATING MICROSCOPE AND DIGITALLY ASSISTED VITREORETINAL SURGERY SYSTEMS
Authors: Park Su Jin , Hwang Jong-Moon , Jae Jin Park Eugene , Shin Jae Pil , Park Dong Ho
Published: March 2022

Purpose:

To quantitatively analyze surgical ergonomics between standard operating microscope (SOM) and digitally assisted vitreoretinal surgery (DAVS) systems.

Methods:

The surgeon conducted procedures on 110 patients; 52 patients underwent a combined phacoemulsification and pars plana vitrectomy (Phaco-PPV group, 24 using SOM and 28 using DAVS), and 58 patients underwent phacoemulsification (Phaco group, 30 using SOM and 28 using DAVS). The surgeon's muscle tone and stiffness in the sternocleidomastoid and the two positions of the upper trapezius (UT), which are 2-cm intervals along the UT muscle fibers, UT1 and UT2, were measured at preoperative, intraoperative, and postoperative time points.

Results:

In the Phaco-PPV group using the SOM, intraoperative muscle tone and stiffness were higher than preoperative and postoperative values in the sternocleidomastoid (P < 0.001, respectively), UT1 (P < 0.001, respectively), and UT2 (P < 0.001 and P < 0.01, respectively). In the Phaco group using the SOM, intraoperative muscle tone and stiffness were higher than pre- and postoperative values in the sternocleidomastoid (P < 0.001, respectively) and UT1 (P < 0.001 and P < 0.01, respectively). By contrast, when the surgeon used the DAVS, there were no differences in muscle properties at any measurement site or during any time point in the Phaco-PPV and Phaco groups (P > 0.05).

Conclusion:

This study provides quantitative measurement of retina surgeon ergonomics, suggesting that compared with a SOM, the DAVS can reduce intraoperative muscle fatigue.
Influence of Posterior Corneal Asphericity On Power Calculation Error After Laser In Situ Keratomileusis or Photorefractive Keratectomy for Myopia
Authors: Rabinovich Mark , Aramburu del Boz Ana , Birk Ulla , Al Khatib Danial , Shoham-Hazon Nir , Bovet Jerome
Published: March 2022

Objectives:

To assess the impact of posterior corneal asphericity on postoperative calculation error using the Haigis-L and the Barrett formulas for eyes after laser in situ keratomileusis or photorefractive keratectomy (PRK).

Methods:

We assessed the mean absolute error (MAE) of two power calculation formulas, Barrett true-K and Haigis-L formulas, in a retrospective analysis of 34 eyes of 34 patients who underwent cataract surgery. We performed a regression analysis between corneal parameters (anterior and posterior Q values, Kmax, K1, and K2) and the MAE of each formula.

Results:

In the cohort, 11 eyes were of women and 23 of men. The average age of the study population was 66.5±8.6 years. The mean axial length was 24±4.7 mm, the mean anterior chamber depth was 3.27±0.7 mm, and the mean posterior Q-value was −0.15±0.28. The MAE of Haigis-L and Barrett true-K formulas were 0.72 and 0.68, respectively (P=0.54). The regression analysis showed a statistically significant relationship only between the error in refraction prediction and the posterior Q-value regardless of the formula used. The coefficient of determination was higher for the Barrett true-K formula (r=0.52; R2=0.28; P<0.05), compared with the Haigis-L (r=0.49; R2=0.25; P<0.05).

Conclusions:

Posterior corneal surface asphericity influences the refractive error of calculation using both Haigis-L and Barrett true-K formulas for eyes after a myopic PRK or laser-assisted in situ keratomileusis surgery.
Role of Different Types of Contact Lenses in Epithelial Thickness
Authors: Abdolalizadeh Parya , Karimi Morteza , Latifi Golshan , Nouri Leila , Hashemian Mohammad-Naser , Hashemian Hesam , Mehrpour Mohammad , Alipour Fateme
Published: March 2022

Objective:

To evaluate the potential role of different types of contact lenses, such as soft (SCL), hard (HCL), and mini scleral (SCCL), in corneal epithelial thickness with anterior segment optical coherence tomography (AS-OCT).

Methods:

In this cross-sectional study, patients who used contact lens at recent 6 months were recruited consecutively from September 2019 to October 2019, and the epithelial thicknesses of the cornea were obtained by AS-OCT and compared with control subjects who did not use contact lens.

Results:

In total, 184 eyes (115 subjects) were included; of them, 75 eyes were keratoconic (KCN) and 109 eyes were nonkeratoconic (non-KCN). Twenty eyes in KCN and 79 eyes of non-KCN group had no history of contact lens use and were included for comparison with KCN and non-KCN contact lens users, respectively. Mean duration of contact lens wearing was 75.63±50.42 months. The epithelial thickness of non-KCN SCL group was thinner than that of non-KCN control subjects all over the cornea, whereas the epithelium of non-KCN HCL was thinner at central site as well as nasal and temporal paracentral and midperipheral areas. Epithelial thickness of the KCN HCL group was not different from the KCN control subjects in all sectors. The KCN SCCL group had thinner epithelium at nearly all peripheral sectors as well as inferior, inferotemporal, inferonasal, and nasal midperipheral sectors compared with KCN control subjects.

Conclusion:

The corneal epithelium was thinner at the peripheral zones in KCN SCCL users; at both peripheral and central zones in non-KCN SCL users and in central zones in non-KCN HCL users.
Comparative Analysis of the Clinical Outcomes of Mix-and-Match Implantation of an Extended Depth-of-Focus and a Diffractive Bifocal Intraocular Lens
Authors: Kim Seonjoo , Yi Rowoon , Chung So-Hyang
Published: March 2022

Objectives:

To evaluate and compare the clinical outcomes of the extended depth-of-focus intraocular lens (EDOF-IOL) and the diffractive bifocal IOL.

Methods:

Fifty-six eyes of 28 patients underwent cataract surgery with implantation of an EDOF-IOL (TECNIS Symfony, ZXR00) in their dominant eye and a diffractive bifocal IOL (+3.25 D add TECNIS ZLB00) in their nondominant eye. Monocular and binocular uncorrected distance, intermediate and near visual acuity, defocus curves, contrast sensitivity, patient satisfaction score (0–5), and spectacle dependence at near vision were evaluated at 3 months after the surgery.

Results:

Postoperative binocular uncorrected distant visual acuity was 0.009±0.031 logMAR, uncorrected intermediate visual acuity was 0.090±0.158 logMAR, and uncorrected near visual acuity was 0.099±0.068 logMAR. The monocular defocus curve demonstrated better performance at intermediate distance in eyes with an EDOF-IOL and better performance at near distance in eyes with a diffractive bifocal IOL. An EDOF-IOL exhibited better outcomes in contrast sensitivity compared with a diffractive bifocal IOL. Three patients (10.7%) required glasses for near vision.

Conclusion:

Mix-and-match implantation of a diffractive bifocal IOL with an EDOF-IOL provides an excellent range of vision, and high levels of contrast sensitivity and patient satisfaction.
Scleral Lens Thickness and Corneal Edema Under Open Eye Conditions
Authors: Fisher Damien , Collins Michael J. , Vincent Stephen J.
Published: March 2022

Purpose:

To examine the relationship between lens thickness and central corneal edema during short-term open-eye scleral lens wear, and to compare these empirical edema measurements with theoretical modelling.

Methods:

Nine participants (mean age 30 years) with normal corneas wore scleral lenses {Dk 141×10−11 cm3 O2 [cm]/([sec] [cm2] [mm Hg])} under open-eye conditions on separate days with nominal center thicknesses of 150, 300, 600, and 1,200 μm. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography immediately after lens application and after 90 min of wear, before lens removal.

Results:

Central corneal edema was primarily stromal in nature and increased with increasing central lens thickness. The mean±standard error total corneal edema was 1.14±0.22%, 1.36±0.26%, 1.74±0.30%, and 2.13±0.24% for the 150, 300, 600, and 1,200 μm lenses, respectively. A significant difference in stromal and total corneal edema was observed between the 1,200 and 150 μm thickness lenses only (both P<0.05). Theoretical modelling overestimated the magnitude of central corneal edema and the influence of central lens thickness when the scleral lens Dk/t was less than 20.

Conclusion:

Scleral lens-induced central corneal edema during short-term open-eye lens wear increases with increasing central lens thickness. Theoretical models overestimated the effect of increasing scleral lens thickness upon central corneal edema for higher lens thickness values (lens Dk/t<20) when controlling for initial central fluid reservoir thickness.
Microbial Keratitis Associated With Penetrating Keratoplasty and Scleral Lens Wear: A Case Series
Authors: Kawulok Eric R. , Nau Cherie B. , Schornack Muriel M.
Published: March 2022

Objectives:

To report on microbial keratitis (MK) in three scleral lens (SL) wearers who had undergone penetrating keratoplasty (PKP).

Methods:

This retrospective case series describes 3 cases of MK in patients who wore SLs after PKP.

Results:

All three patients wore SLs for visual rehabilitation for corneal irregularity induced by PKP; all three also had concurrent ocular surface disease (keratoconjunctivitis sicca and corneal exposure). Cultures identified the causative organism in two patients, and septated hyphae suggestive of fungal infection were identified in tissue removed during therapeutic PKP in the third patient. All three patients were receiving either topical or systemic immunosuppressive therapy before the infection developed.

Conclusions:

Scleral lenses are often used to manage complex ocular disease, which can make it difficult to determine the precise cause of complications that arise after wearing the lenses. Multiple factors, including SL wear, may have contributed to the initial development of MK in the three patients in this case series. Patients who wear SLs after PKP should be monitored closely.
The Impact of Australian Childhood Vaccination Mandates on Immunization Specialists and Their Interactions With Families
Authors: Yap Natalie , Buttery Jim , Crawford Nigel W. , Omer Saad , Heininger Ulrich ,   on behalf of the AEFI CAN Group
Published: March 2022

Background:

Recent global outbreaks of vaccine-preventable diseases, both before and since the coronavirus disease 2019 pandemic, have led to the introduction or strengthening of vaccine mandate policies to target vaccine refusal. Globally, there is wide variation in how governments and jurisdictions implement and enforce mandatory vaccination as well as the financial and educational consequences to those who fail to comply. We explored the impact of mandate vaccination policies on Australian Immunization Specialists who work in Specialist Immunization Clinics (SIC) for approving vaccine exemptions outside of the mandated criteria. In particular, their interactions with patients and families.

Methods:

A national, prospective, mixed methods, survey-based study conducted with members of the Australian Adverse Event Following Immunisation Clinical Assessment Network between February 2020 and June 2020.

Results:

Sixteen Immunization physicians and nurse practitioner specialists working in a SIC completed the survey. All sixteen respondents had been requested by parents to provide a Medical Exemptions at least once. 88% of respondents felt pressure to provide an exemption that was not medically justified according to legislation. Seventy-five percent of SIC consultants felt that the “No Jab” policies created a moderate or extreme amount of stress to both themselves and parents. All respondents reported experiencing hostility from parents with three respondents having received threats of violence.

Conclusions:

Mandatory vaccination policies are associated with increased vaccination coverage but can result in widened financial and social inequity, and may harm families’ relationships with health care providers. Countries considering the implementation of vaccination mandates should use the least restrictive health policies to ensure a balance between the public health and individual benefit whilst minimizing burdens on health care professionals, children and their parents.
Are We Hitting the Target?
Authors: Elrod Julia , Yarmal Fatima , Mohr Christoph , Dennebaum Martin , Boettcher Michael , Vincent Deirdre , Reinshagen Konrad , Koenigs Ingo
Published: March 2022

Background:

Currently, a range of different antibiotics are administered perioperatively during appendectomy surgery in the pediatric population. One reason for the lack of a uniform treatment regimen is the paucity of large studies on microbiologic data and susceptibility patterns.

Methods:

A retrospective, monocentric study on antibiotic susceptibility, including 1258 pediatric patients undergoing appendectomy from 2012 to 2020 was performed. Predictors for prolonged length of stay (LOS) and complications were determined using regression analysis, and objective criteria for broad-spectrum antibiotic regimens were identified. Simulations of the effectiveness of different antibiotic regimens against identified bacterial susceptibility results were conducted.

Results:

The most important predictors for prolonged LOS and an increased incidence of infectious complications are elevated preoperative C-reactive protein levels, high intraoperative severity gradings and insufficient primary antibiotic treatment. Based on our results, a simple antibiotic treatment, consisting of cefuroxime-metronidazole (C-M) or ampicillin-sulbactam (AS), is sufficient in around 85% of all patients; both options being equally efficient. In severe appendicitis, the likelihood of resistance is 31% and 32% for C-M and AS, respectively. For piperacillin-tazobactam and C-M-tobramycin, the incidence of bacterial resistance decreases to 12%. Resistance is reduced to 8% for AS-tobramycin treatment. The patient populations benefiting most from an extended antibiotic regimen are those with a high intraoperative severity grading.

Conclusions:

Evidence suggests that an insufficient antibiotic regimen is associated with a prolonged LOS and a higher rate of infectious complications, justifying the expansion of a simple antibiotic regimen in cases of severe intraabdominal findings. In all other cases, a simple antibiotic treatment with AS is recommended.