bluuebunny/crossref_metadata_2025 huggingface dataset:
Three Separate Clinical Entities of Infective Endocarditis—A Population-Based Study From Southern Finland 2013–2017
Authors: Halavaara Mika , Martelius Timi , Anttila Veli-Jukka , Järvinen Asko
Published: August 2020

Background

Health care–associated infective endocarditis (HAIE) and intravenous drug use–related IE (IDUIE) have emerged as major groups in infective endocarditis (IE). We studied their role and clinical picture in a population-based survey.

Methods

A population-based retrospective study including all adult patients diagnosed with definite or possible IE in Southern Finland in 2013–2017. IE episodes were classified according to the mode of acquisition into 3 groups: community-acquired IE (CAIE), HAIE, and IDUIE.

Results

Total of 313 episodes arising from 291 patients were included. Incidence of IE was 6.48/100 000 person-years. CAIE accounted for 38%, HAIE 31%, and IDUIE 31% of IE episodes. Patients in the IDUIE group were younger, and they more frequently had right-sided IE (56.7% vs 5.0%; P < .001) and S. aureus as etiology (74.2% vs 17.6%; P < .001) compared with the CAIE group. In-hospital (15.1% vs 9.3%; P = .200) and cumulative 1-year case fatality rates (18.5% vs 17.5%; P = .855) were similar in CAIE and IDUIE. Patients with HAIE had more comorbidities, prosthetic valve involvement (29.9% vs 10.9%; P = .001), enterococcal etiology (20.6% vs 5.9%; P = .002), and higher in-hospital (27.8% vs 15.1%; P = .024) and cumulative 1-year case fatality rates (43.3% vs 18.5%; P < .001) than patients with CAIE. Staphylococcus aureus caused one-fifth of IE episodes in both groups.

Conclusions

Our study indicates that in areas where injection drug use is common IDUIE should be regarded as a major risk group for IE, along with HAIE, and not seen as part of CAIE. Three different risk groups, CAIE, HAIE, and IDUIE, with variable characteristics and outcome should be recognized in IE.
Changes in Waist Circumference in HIV-Infected Individuals Initiating a Raltegravir or Protease Inhibitor Regimen: Effects of Sex and Race
Authors: Bhagwat Priya , Ofotokun Ighovwerha , McComsey Grace A , Brown Todd T , Moser Carlee , Sugar Catherine A , Currier Judith S
Published: August 2020

Background

This study investigates the association of clinical and demographic predictors with abdominal fat gain, measured using waist circumference (WC) and self-reported abdominal size.

Methods

We analyzed data from ACTG A5257, a clinical trial that randomized treatment-naïve HIV-infected participants to 1 of 3 antiretroviral regimens: raltegravir (RAL) or the protease inhibitors (PIs) atazanavir/ritonavir (ATV/r) or darunavir/ritonavir (DRV/r), each in combination with tenofovir disoproxil fumarate/emtricitabine. Associations of treatment and baseline/demographic characteristics with 96-week WC change were assessed using repeated-measures models. Ordinal logistic regression was used to examine the associations of predictors with week 96 self-reported abdominal changes.

Results

The study population (n = 1809) was 76.0% male and predominantly black non-Hispanic (41.9%) and white non-Hispanic (34.1%). Mean baseline WC was 90.6 cm, with an average 96-week increase of 3.4 cm. WC increases were higher in the RAL arm compared with DRV/r (P = .0130). Females experienced greater increases in WC on RAL vs ATV/r than males (P = .0065). Similarly, a larger difference in WC change was found for RAL vs DRV/r for black vs nonblack individuals (P = .0043). A separate multivariable model found that in addition to the treatment regimen, higher baseline viral load and lower CD4+ were also associated with WC increases.

Conclusions

With antiretroviral therapy initiation, higher WC increases in the RAL arm compared with PIs were more pronounced in female and black participants, and a more advanced baseline HIV disease state was a strong predictor of larger abdominal increases. Understanding factors predisposing individuals to abdominal fat gain could inform health management after therapy initiation.
Negative pressure ventilation as a bridge to lung transplant
Authors: Martínez María D P , Alvarez Francisco G , Mallea Jorge M , Shah Sadia Z , Pham Si M , El-Sayed Ahmed Magdy M , Jacob Samuel , Janik Anthony B , Haddad Tarik , Erasmus David B , Narula Tathagat
Published: August 2020

Recent years have witnessed evolution of lung allocation strategies to prioritize sicker recipients. In the pre-transplant period, this has translated into increased utilization of invasive extracorporeal or mechanical ventilatory support as a bridge to lung transplantation. The morbidity associated with these strategies warrants consideration to less invasive respiratory support modalities. Herein, we present a case highlighting successful bridge to lung transplantation with a relatively non-invasive negative pressure ventilator.
Hippopotamus bite morbidity: a report of 11 cases from Burundi
Authors: Haddara Moustafa M , Haberisoni Jean Berchmans , Trelles Miguel , Gohou Jean-Paul , Christella Kwizera , Dominguez Lynette , Ali Engy
Published: August 2020

Hippopotamus is one of the most-loved animals in Africa, yet it is aggressive and dangerous. The co-existence of humans in close proximity to their natural habitat increases the probability of human injury. Hippopotamus attacks have long been recognized to cause serious injuries, but its magnitude and burden are still unknown. The medical literature is very scarce when it comes to documenting hippopotamus bite injuries and their outcomes. We present a cohort of 11 patients who suffered hippopotamus bite injuries in Burundi. To our knowledge, this is the largest case series reporting on the clinical presentation, injury patterns and surgical outcomes of hippopotamus bites. The results show a high incidence of wound infections, amputations and permanent disability among other complications. Hippopotamus-inflicted injuries should, therefore, be triaged as major trauma rather than just ‘mammalian bites’.
The balloon impasse sign in percutaneous transvenous mitral valvuloplasty
Authors: Simard Trevor , Thangarasa Tharshika , Di Santo Pietro , Labinaz Alisha , Hibbert Benjamin
Published: August 2020

Percutaneous transvenous mitral valvuloplasty (PTMV) is an established therapy for rheumatic mitral stenosis (MS). While the Wilkins score standardizes the description of valve anatomy and predicts successful PTMV, echocardiographic assessment has some limitations. The ‘balloon impasse’ sign is the inability to cross a stenotic valve with a deflated Inoue balloon. This sign was described in the 1990s as an indicator of severe subvalvular thickening (regardless of the echocardiographic findings), portending an increased risk of severe mitral regurgitation (MR) post-PTMV. Despite its implications for management, it has been seldom reported. A 57-year-old woman with symptomatic, severe MS and a Wilkins score of 7 underwent PTMV. The ‘balloon impasse’ sign was observed when attempting to cross the stenotic valve. When the balloon was fully inflated, severe MR was noted, and the patient required mitral valve replacement. This case demonstrates the continued importance of the ‘balloon impasse’ sign and its implications for the therapeutic efficacy of PTMV.
Bilateral Mondor’s disease in chikungunya virus infection
Authors: Djebara Sarah , Henckaerts Liesbet , Vanbrabant Peter
Published: August 2020

Chikungunya virus (CHIKV) is an arthropod-borne virus that is transmitted by Aedes mosquitoes, and its main features are high fever and (debilitating) arthritis. Infection with CHIKV, as well as other viruses, has been associated with hypercoagulable states and may be linked with the development of venous thrombosis. In fact, the development of deep venous thrombosis has been described in CHIKV infection. We present a case of superficial thrombophlebitis of the thoracic wall, known as Mondor’s disease, associated with CHIKV infection. To our knowledge, this probable association has never been described before.
Using social media to analyze public psychological status during the recovery period of COVID-19 in China
Authors: Jia Fei , Liu Xiaoguang
Published: August 2020

Background

During the outbreak, billions of people were eager to get information about COVID-19 through social media. Social media can not only deliver reliable information to the public but can in turn reflect changes in the public’s psychological status. Insight into the public’s hotspots of concern and mental status through media background tools contributes to the formulation of public health policies and the clarification of epidemic development mode.

Methods

WeChat is the largest social media in China. Taking the recovery period of COVID-19 in China, for example, we collected WeChat Index data and analyzed the public’s concern about the course of COVID-19 and the restoration of emotional tendency through keywords search.

Results

With the gradual control of the COVID-19 in China, the public psychological status changes from negative to neutral, accompanied by a weakening of negative emotions and an increase in positive emotions. Every obvious inflection point of improvement in social operation is reflected in the increase of public attention and the relaxation of lifestyle.

Conclusions

Social media can be used to monitor the public psychological status and the development mode and trend of infection in one country during a pandemic.
Symptom Remission and Brain Cortical Networks at First Clinical Presentation of Psychosis: The OPTiMiSE Study
Authors: Dazzan Paola , Lawrence Andrew J , Reinders Antje A T S , Egerton Alice , van Haren Neeltje E M , Merritt Kate , Barker Gareth J , Perez-Iglesias Rocio , Sendt Kyra-Verena , Demjaha Arsime , Nam Kie W , Sommer Iris E , Pantelis Christos , Wolfgang Fleischhacker W , van Rossum Inge Winter , Galderisi Silvana , Mucci Armida , Drake Richard , Lewis Shon , Weiser Mark , Martinez Diaz-Caneja Covadonga M , Janssen Joost , Diaz-Marsa Marina , Rodríguez-Jimenez Roberto , Arango Celso , Baandrup Lone , Broberg Brian , Rostrup Egill , Ebdrup Bjørn H , Glenthøj Birte , Kahn Rene S , McGuire Philip ,   OPTiMiSE study group
Published: August 2020

Individuals with psychoses have brain alterations, particularly in frontal and temporal cortices, that may be particularly prominent, already at illness onset, in those more likely to have poorer symptom remission following treatment with the first antipsychotic. The identification of strong neuroanatomical markers of symptom remission could thus facilitate stratification and individualized treatment of patients with schizophrenia. We used magnetic resonance imaging at baseline to examine brain regional and network correlates of subsequent symptomatic remission in 167 medication-naïve or minimally treated patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder entering a three-phase trial, at seven sites. Patients in remission at the end of each phase were randomized to treatment as usual, with or without an adjunctive psycho-social intervention for medication adherence. The final follow-up visit was at 74 weeks. A total of 108 patients (70%) were in remission at Week 4, 85 (55%) at Week 22, and 97 (63%) at Week 74. We found no baseline regional differences in volumes, cortical thickness, surface area, or local gyrification between patients who did or did not achieved remission at any time point. However, patients not in remission at Week 74, at baseline showed reduced structural connectivity across frontal, anterior cingulate, and insular cortices. A similar pattern was evident in patients not in remission at Week 4 and Week 22, although not significantly. Lack of symptom remission in first-episode psychosis is not associated with regional brain alterations at illness onset. Instead, when the illness becomes a stable entity, its association with the altered organization of cortical gyrification becomes more defined.
Physical, Cultural, and Chemical Alternatives for Integrated Management of Charcoal Rot of Strawberry
Authors: Baggio Juliana S. , Ruschel Rafaela G. , Noling Joseph W. , Peres Natalia A.
Published: August 2020

Macrophomina phaseolina, the causal agent of charcoal rot in strawberry, induces plant wilting and collapse. The pathogen survives through the production of microsclerotia in the soil and in strawberry debris. However, its management is difficult, and the disease has become an increasing problem for the strawberry industry. Physical, cultural, and chemical alternatives for integrated management of charcoal rot were evaluated in laboratory and field trials during the 2017–18 and 2018–19 strawberry seasons. In a laboratory trial, M. phaseolina microsclerotia were subjected to heat treatment and germination was inhibited at 52, 56, 80, and 95°C after 30, 10, 1, and 0.5 min of exposure, respectively. In infected strawberry crowns, microsclerotial viability was reduced after 5 min, regardless of temperature, whereas in the field, reduction was observed after 1 min. In field trials, charcoal rot incidence of inoculated strawberry plants transplanted into white-striped plastic-mulched beds was reduced to 20.8%, compared with 60.8% for plants grown in the black plastic mulch. On commercial farms, crop residue removal from infested areas reduced the M. phaseolina population in the soil but did not decrease charcoal rot incidence. Moreover, M. phaseolina propagule densities in the soil and in strawberry debris was reduced by fumigant application at crop termination but surviving propagules allowed the population to increase over the summer. Furthermore, preplant fumigation with metam potassium reduced soil population and charcoal rot incidence. Overall, the adoption of integrated approaches such as physical, chemical, and/or cultural methods played a significant role in reducing M. phaseolina inoculum and contributed to control of the disease in areas with high disease pressure.
Bamboo Tar as a Novel Fungicide: Its Chemical Components, Laboratory Evaluation, and Field Efficacy Against False Smut and Sheath Blight of Rice and Powdery Mildew and Fusarium Wilt of Cucumber
Authors: Maliang Huidong , Wang Pinwei , Chen Anliang , Liu Hongbo , Lin Haiping , Ma Jianyi
Published: August 2020

The application of agricultural and forest residues can benefit the environment and the economy; however, they also generate a large amount of byproducts. In this study, bamboo tar (BT), a waste product of bamboo charcoal production, was dissolved in natural ethanol and the surfactant alkyl glucoside to manufacture a 50% (wt/wt) BT emulsifiable concentrate (BTEC) biopesticide. BTEC was screened for fungicidal activity against pathogens. The greatest activity was seen against Ustilaginoidea virens with a half-maximal effective concentration (EC50) value of 6 mg/liter. Four phytopathogenic fungi, Podosphaera xanthii, Rhizoctonia solani, Fusarium oxysporum, and Botrytis cinerea, showed EC50 values of <60 mg/liter. Greenhouse tests in vivo showed 2,000 mg/liter BTEC had a 78.4% protective effect against U. virens, and replicated treatments had an 80.6% protective effect. In addition, replicated 2-year field trials were conducted in two geographic locations with four plant diseases: false smut (U. virens), rice sheath blight (Thanatephorus cucumeris [Frank] Donk), cucumber powdery mildew (P. xanthii), and cucumber Fusarium wilt (F. oxysporum). Results showed that 1,000 to 2,000 mg/liter BTEC significantly inhibited these diseases. Gas chromatography–mass spectrometry analysis showed that the total phenolic mass fractions of two BT samples were 45.39 and 48.26%. Eleven components were detected, and their percentage content was as follows (from high to low): 2,6-dimethoxyphenol > 2- or 4-ethylphenol > 2- or 4-methylphenol > phenol > 4-ethylguaiacol > dimethoxyphenol > 4-methylguaiacol > 4-propenyl-2,6-dimethoxyphenol > 2,4-dimethylphenol. Some of the phenolic compounds identified from the tar might be fungicidally active components. BT is a biochar waste, which has potential as a biofungicide and has promise in organic agriculture. The value of this tar may not be because of any fundamental physical differences from other synthetic fungicides but rather caused by reduced production expenses and more efficient use of waste products.
A snapshot of clinical educational experiences for advanced practice nurses worldwide
Authors: Beauchesne Michelle A. , Honig Judy , Sevilla Sonia , Carryer Jenny , Debout Christophe , Ganz Freda DeKeyser , East Linda Anne , Fraser Debbie , Hibbert Denise , Scanlon Andrew , Spooner Paula
Published: August 2020

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.
Cognitive Functions and Impact of Plasma BDNF in Chronic Heroin Users
Authors: Soliman Alaa , Zaki Nivert , El-Ghonemy Soheir H. , El Ghamry Reem , Shorub Eman , Farag Mahmoud
Published: August 2020

Background:

Recent evidence suggests that abusing drugs may alter the normal structure in brain regions and influence functions that induce cognitive deficits and promote continued drug use.

Objective:

The objective of this study was to assess the pattern of cognitive dysfunctions in patients with chronic heroin use and to explore any relation to brain-derived neurotrophic factor (BDNF) plasma level.

Method:

This was a case-control naturalistic cross-sectional study of 50 patients (case group) with chronic heroin use according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) who were recruited from the inpatient unit and outpatient clinics of Institute of Psychiatry, Ain Shams University, and were further compared with a control group that consisted of 38 frequency-matched healthy volunteers. The groups were subjected to the following: (1) clinical psychiatric examination, (2) Structured Clinical Interview for DSM-IV (SCID-I), (3) Addiction Severity Index for the patients’ group, (4) Wechsler Adults Intelligence Scale, (5) Wechsler Memory Scale, (6) Wisconsin Card Sorting Test—computerized version was performed to assess cognitive functions, and (7) measuring BDNF plasma level.

Results:

Definite cognitive function impairment and poor cognitive domains were detected among the case group. Total intellectual functions, and visual, verbal, immediate memory, and executive functions were statistically significant (P<0.005). Although, there was no significance between BDNF plasma level and different neurocognitive functions, higher BDNF plasma level among the case group was detected.

Limitation:

Premorbid cognitive abilities could not be assessed, as the current study was a cross-sectional study.

Conclusions:

Those with chronic heroin use suffer from cognitive dysfunction of multiple domains that may contribute to their continued drug use. Psychotherapeutic programs should consider these findings in their approaches for better impact on patients’ quality of life and overall treatment outcome.
Neonatal Isoflurane Anesthesia or Disruption of Postsynaptic Density-95 Protein Interactions Change Dendritic Spine Densities and Cognitive Function in Juvenile Mice
Authors: Schaefer Michele L. , Perez Patric J. , Wang Meina , Gray Christy , Krall Caroline , Sun Xiaoning , Hunter Elizabeth , Skinner John , Johns Roger A.
Published: August 2020

Background

Experimental evidence shows postnatal exposure to anesthesia negatively affects brain development. The PDZ2 domain, mediating protein–protein interactions of the postsynaptic density-95 protein, serves as a molecular target for several inhaled anesthetics. The authors hypothesized that early postnatal disruption of postsynaptic density-95 PDZ2 domain interactions has persistent effects on dendritic spines and cognitive function.

Methods

One-week-old mice were exposed to 1.5% isoflurane for 4 h or injected with 8 mg/kg active postsynaptic density-95 wild-type PDZ2 peptide along with their respective controls. A subset of these mice also received 4 mg/kg of the nitric oxide donor molsidomine. Hippocampal spine density, long-term potentiation, novel object recognition memory, and fear learning and memory were evaluated in mice.

Results

Exposure of 7-day-old mice to isoflurane or postsynaptic density-95 wild-type PDZ2 peptide relative to controls causes: (1) a long-term decrease in mushroom spines at 7 weeks (mean ± SD [spines per micrometer]): control (0.8 ± 0.2) versus isoflurane (0.4 ± 0.2), P < 0.0001, and PDZ2MUT (0.7 ± 0.2) versus PDZ2WT (0.4 ± 0.2), P < 0.001; (2) deficits in object recognition at 6 weeks (mean ± SD [recognition index]): naïve (70 ± 8) versus isoflurane (55 ± 14), P = 0.010, and control (65 ± 13) versus isoflurane (55 ± 14), P = 0.045, and PDZ2MUT (64 ±11) versus PDZ2WT (53 ± 18), P = 0.045; and (3) deficits in fear learning at 7 weeks and memory at 8 weeks (mean ± SD [% freezing duration]): Learning, control (69 ± 12) versus isoflurane (52 ± 13), P < 0.0001, and PDZ2MUT (65 ± 14) versus PDZ2WT (55 ± 14) P = 0.011, and Memory, control (80 ± 17) versus isoflurane (56 ± 23), P < 0.0001 and PDZ2MUT (73 ± 18) versus PDZ2WT (44 ± 19) P < 0.0001. Impairment in long-term potentiation has fully recovered here at 7 weeks (mean ± SD [% baseline]): control (140 ± 3) versus isoflurane (137 ± 8), P = 0.560, and PDZ2MUT (136 ± 17) versus PDZ2WT (128 ± 11), P = 0.512. The isoflurane induced decrease in mushroom spines was preventable by introduction of a nitric oxide donor.

Conclusions

Early disruption of PDZ2 domain-mediated protein–protein interactions mimics isoflurane in decreasing mushroom spine density and causing learning and memory deficits in mice. Prevention of the decrease in mushroom spine density with a nitric oxide donor supports a role for neuronal nitric oxide synthase pathway in mediating this cellular change associated with cognitive impairment.

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Anesthetic and Analgesic Drug Products Advisory Committee Activity and Decisions in the Opioid-crisis Era
Authors: Litman Ronald S.
Published: August 2020

The United States Food and Drug Administration is tasked with ensuring the efficacy and safety of medications marketed in the United States. One of their primary responsibilities is to approve the entry of new drugs into the marketplace, based on the drug’s perceived benefit–risk relationship. The Anesthetic and Analgesic Drug Product Advisory Committee is composed of experts in anesthesiology, pain management, and biostatistics, as well as consumer and industry representatives, who meet several times annually to review new anesthetic-related drugs, those seeking new indications, and nearly every opioid-related application for approval. The following report describes noteworthy activities of this committee since 2017, as it has grappled, along with the Food and Drug Administration, to balance the benefit–risk relationships for individual patients along with the overarching public health implications of bringing additional opioids to market. All anesthesia advisory committee meetings since 2017 will be described, and six will be highlighted, each with representative considerations for potential new opioid formulations or local anesthetics.
Positional Therapy and Regional Pulmonary Ventilation
Authors: Xin Yi , Cereda Maurizio , Hamedani Hooman , Martin Kevin T. , Tustison Nicholas J. , Pourfathi Mehrdad , Kadlecek Stephen , Siddiqui Sarmad , Amzajerdian Faraz , Connell Marc , Abate Nicholas , Kajanaku Agi , Duncan Ian , Gee James C. , Rizi Rahim R.
Published: August 2020

Background

Prone ventilation redistributes lung inflation along the gravitational axis; however, localized, nongravitational effects of body position are less well characterized. The authors hypothesize that positional inflation improvements follow both gravitational and nongravitational distributions. This study is a nonoverlapping reanalysis of previously published large animal data.

Methods

Five intubated, mechanically ventilated pigs were imaged before and after lung injury by tracheal injection of hydrochloric acid (2 ml/kg). Computed tomography scans were performed at 5 and 10 cm H2O positive end-expiratory pressure (PEEP) in both prone and supine positions. All paired prone–supine images were digitally aligned to each other. Each unit of lung tissue was assigned to three clusters (K-means) according to positional changes of its density and dimensions. The regional cluster distribution was analyzed. Units of tissue displaying lung recruitment were mapped.

Results

We characterized three tissue clusters on computed tomography: deflation (increased tissue density and contraction), limited response (stable density and volume), and reinflation (decreased density and expansion). The respective clusters occupied (mean ± SD including all studied conditions) 29.3 ± 12.9%, 47.6 ± 11.4%, and 23.1 ± 8.3% of total lung mass, with similar distributions before and after lung injury. Reinflation was slightly greater at higher PEEP after injury. Larger proportions of the reinflation cluster were contained in the dorsal versus ventral (86.4 ± 8.5% vs. 13.6 ± 8.5%, P < 0.001) and in the caudal versus cranial (63.4 ± 11.2% vs. 36.6 ± 11.2%, P < 0.001) regions of the lung. After injury, prone positioning recruited 64.5 ± 36.7 g of tissue (11.4 ± 6.7% of total lung mass) at lower PEEP, and 49.9 ± 12.9 g (8.9 ± 2.8% of total mass) at higher PEEP; more than 59.0% of this recruitment was caudal.

Conclusions

During mechanical ventilation, lung reinflation and recruitment by the prone positioning were primarily localized in the dorso-caudal lung. The local effects of positioning in this lung region may determine its clinical efficacy.

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Development of Rapid Response Capabilities in a Large COVID-19 Alternate Care Site Using Failure Modes and Effect Analysis with In Situ Simulation
Authors: Levy Nadav , Zucco Liana , Ehrlichman Richard J. , Hirschberg Ronald E. , Hutton Johnson Stacy , Yaffe Michael B. , Ramachandran Satya Krishna , Bose Somnath , Leibowitz Akiva
Published: August 2020

Preparedness measures for the anticipated surge of coronavirus disease 2019 (COVID-19) cases within eastern Massachusetts included the establishment of alternate care sites (field hospitals). Boston Hope hospital was set up within the Boston Convention and Exhibition Center to provide low-acuity care for COVID-19 patients and to support local healthcare systems. However, early recognition of the need to provide higher levels of care, or critical care for the potential deterioration of patients recovering from COVID-19, prompted the development of a hybrid acute care–intensive care unit. We describe our experience of implementing rapid response capabilities of this innovative ad hoc unit. Combining quality improvement tools for hazards detection and testing through in situ simulation successfully identified several operational hurdles. Through rapid continuous analysis and iterative change, we implemented appropriate mitigation strategies and established rapid response and rescue capabilities. This study provides a framework for future planning of high-acuity services within a unique field hospital setting.
Reflections on a Service-Learning Project
Authors: Carter Holly W. , Outlaw Kerri L. , Cleveland Kelli K. , Rushing Deborah S. , Chen Nikki L.
Published: August 2020

This article examines the concept of service-learning (SL) in nursing practice and education as an opportunity to promote service, not only to individuals but also to the community. Nursing students conducted a SL nutrition education project at an elementary school in Alabama, a state in which the frequency of obesity is among the highest in the nation. Results suggest that SL enhances the critical thinking and cultural sensitivity of nursing students while helping to solidify nursing skills and values.
DaxibotulinumtoxinA for Injection for the Treatment of Glabellar Lines: Efficacy Results From SAKURA 3, a Large, Open-Label, Phase 3 Safety Study
Authors: Fabi Sabrina G. , Cohen Joel L. , Green Lawrence J. , Dhawan Sunil , Kontis Theda C. , Baumann Leslie , Gross Todd M. , Gallagher Conor J. , Brown Jessica , Rubio Roman G.
Published: August 2020

BACKGROUND

DaxibotulinumtoxinA for Injection (DAXI) is botulinum toxin Type A formulated with a novel peptide excipient. Two pivotal, single-treatment, placebo-controlled trials demonstrated efficacy and safety for moderate or severe glabellar lines.

OBJECTIVE

To further evaluate DAXI in a large, open-label, repeat-treatment study.

METHODS

Subjects (n = 2,691) were enrolled from the preceding pivotal trials or de novo and received 40U DAXI. Those who received repeat treatments could be retreated when they returned to baseline on the Investigator Global Assessment–Frown Wrinkle Severity (IGA-FWS) and Patient FWS (PFWS) scales at/after 12 weeks and up to 36 weeks after treatment.

RESULTS

High (>96%) response rates (none or mild severity) on the IGA-FWS scale were seen after each of the 3 treatments, with peak response between Weeks 2 to 4. At Week 24, ≥32% had a response of none or mild severity. Peak response rates of ≥92% were observed at Weeks 2 to 4 on the PFWS scale. The median duration for return to moderate or severe severity was 24 weeks. The safety profile was favorable and consistent with previous trials.

CONCLUSION

DaxibotulinumtoxinA for Injection efficacy was highly consistent across treatment cycles. These results confirm the previously observed efficacy rates and duration of response.
The potential for overdiagnosis and underdiagnosis because of blood pressure variability: a comparison of the 2017 ACC/AHA, 2018 ESC/ESH and 2019 NICE hypertension guidelines
Authors: Bell Katy , Doust Jenny , McGeechan Kevin , Horvath Andrea Rita , Barratt Alexandra , Hayen Andrew , Semsarian Christopher , Irwig Les
Published: August 2020

Objective:

To estimate the extent that BP measurement variability may drive over- and underdiagnosis of ‘hypertension’ when measurements are made according to current guidelines.

Methods:

Using data from the National Health and Nutrition Examination Survey and empirical estimates of within-person variability, we simulated annual SBP measurement sets for 1 000 000 patients over 5 years. For each measurement set, we used an average of multiple readings, as recommended by guidelines.

Results:

The mean true SBP for the simulated population was 118.8 mmHg with a standard deviation of 17.5 mmHg. The proportion overdiagnosed with ‘hypertension’ after five sets of office or nonoffice measurements using the 2017 American College of Cardiology guideline was 3–5% for people with a true SBP less than 120 mmHg, and 65–72% for people with a true SBP 120–130 mmHg. These proportions were less than 1% and 14–33% using the 2018 European Society of Hypertension and 2019 National Institute for Health and Care Excellence guidelines (true SBP <120 and 120–130 mmHg, respectively). The proportion underdiagnosed with ‘hypertension’ was less than 3% for people with true SBP at least 140 mmHg after one set of office or nonoffice measurements using the 2017 American College of Cardiology guideline, and less than 18% using the other two guidelines.

Conclusion:

More people are at risk of overdiagnosis under the 2017 American College of Cardiology guideline than the other two guidelines, even if nonoffice measurements are used. Making clinical decisions about cardiovascular prediction based primarily on absolute risk, minimizes the impact of blood pressure variability on overdiagnosis.
Orthostatic blood pressure recovery associates with physical performance, frailty and number of falls in geriatric outpatients
Authors: Mol Arjen , Slangen Lois R.N. , van Wezel Richard J.A. , Maier Andrea B. , Meskers Carel G.M.
Published: August 2020

Objective:

Blood pressure (BP) recovery after orthostatic hypotension might be important to prevent cerebral hypoperfusion episodes in older adults, and be related to better clinical outcome. The objective was to study the relationship between BP recovery and clinical outcome, that is physical and cognitive performance, frailty and falls, in geriatric outpatients.

Methods:

One hundred and sixty-eight geriatric outpatients underwent continuous (beat-to-beat) BP measurements during standing up, and a comprehensive geriatric assessment, including assessment of physical performance (chair stand test), cognitive performance (Mini Mental State Examination), frailty (Fried criteria) and falls in the previous year. BP recovery was evaluated at 15–30, 30–60, 60–120 and 120–180 s after standing up and defined as mean SBP and DBP in the respective time intervals minus baseline BP. Associations with clinical outcome were assessed using linear (physical and cognitive performance and frailty) and logistic (falls) regression, adjusting for age, sex, baseline BP and initial BP drop.

Results:

SBP recovery was associated with frailty (30–60 s interval; β = 0.013, P = 0.02) and falls (30–60 s interval; odds ratio = 1.024, P = 0.02). DBP recovery was associated with physical performance (30–60 s interval; β = 0.215, P = 0.01), frailty (30–60 s interval; β = 0.028, P = 0.02) and falls (30–60 s interval; odds ratio = 1.039, P = 0.04). Neither SBP nor DBP recovery was associated with cognitive performance.

Conclusion:

DBP recovery was particularly associated with clinical outcome in geriatric outpatients, suggesting BP recovery to be of clinical interest.
Prevalence and Clinical Manifestations of Congenital Cytomegalovirus Infection in a Screening Program in Madrid (PICCSA Study)
Authors: Blázquez-Gamero Daniel , Soriano-Ramos María , Vicente Marta , Pallás-Alonso Carmen Rosa , Pérez-Rivilla Alfredo , García-Álvarez Mónica , Pinilla Martín María Teresa , Freire Xavier , De Vergas Joaquín , De Aragón Ana Martínez , Zamora Berta , Epalza Cristina , Moraleda Cinta , Rojo Pablo , Prieto Luis , Fernández-Cooke Elisa , Ruíz-Contreras Jesús , Delgado Rafael , Folgueira María Dolores
Published: August 2020

Background:

Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Up to 15%–20% of infected newborns will develop long-term sequelae such as hearing loss and neurologic abnormalities. The aim of this study was to investigate the prevalence of congenital CMV infection (cCMV) and associated clinical abnormalities in Spain.

Methods:

A prospective screening for cCMV by viral load in saliva was performed. Saliva samples were obtained within the first 72 hours of life in a maternity ward in Madrid (Spain), during a 1-year period. All positive screening tests were confirmed with viral load in urine. Clinical, laboratory, auditory, visual and cerebral imaging assessments were performed in all children with cCMV.

Results:

Of the 4097 neonates born during the study period, 3190 (78%) were included. CMV viral load in saliva was detectable in 24/3190 (0.75%) children, and congenital infection was confirmed in 15/3190 (0.47%, CI 95%: 0.29%–0.77%). Positive predictive value was 62.5% (CI 95%: 46.5%–76.1%). Two infants presented symptoms at birth. Eight (53.3%) children showed abnormalities in magnetic resonance imaging; most of them isolated white matter abnormalities. Newborns with abnormalities in magnetic resonance imaging showed higher viral loads in blood and saliva (P = 0.04).

Conclusions:

One in 200 neonates born in our hospital presented a cCMV infection. CMV viral load in saliva has been shown to be a simple and highly accepted screening method but should be confirmed by CMV detection in urine. In spite of the fact that half of infected children had abnormalities in cerebral imaging, diagnosis during the neonatal period would have been impossible without a screening program in most cases.
Effect of Social Distancing Due to the COVID-19 Pandemic on the Incidence of Viral Respiratory Tract Infections in Children in Finland During Early 2020
Authors: Kuitunen Ilari , Artama Miia , Mäkelä Lotta , Backman Katri , Heiskanen-Kosma Tarja , Renko Marjo
Published: August 2020

Background:

Social distancing measures are used to reduce the spreading of infection. Our aim was to assess the immediate effects of national lockdown orders due to coronavirus disease 2019 (COVID-19) on pediatric emergency room (ER) visits and respiratory tract infections in hospitals and nationwide in Finland.

Methods:

This register-based study used hospital patient information systems and the Finnish national infectious disease register. The participants were all patients visiting pediatric ER in 2 Finnish hospitals (Kuopio University Hospital, Mikkeli Central Hospital) covering 1/5th of the Finnish children population, 4 weeks before and 4 weeks after the start of the nationwide lockdown on March 16, 2020. Nationwide weekly numbers of influenza (A + B) and respiratory syncytial virus (RSV) in children were assessed from the infectious disease register from 2015 to 2020.

Results:

A major decrease in the rate of daily median pediatric ER visits was detected in both hospitals in the study during the nationwide lockdown compared with the study period before the lockdown (Mikkeli, 19 vs. 7, P < 0.001; Kuopio, 9 vs. 2,5, P < 0.001). The influenza season was shorter (8 weeks from peak to no cases), and the weekly rate of new cases decreased faster compared with the previous 4 influenza seasons (previously 15–20 weeks from peak to no cases). A similar decrease was also seen in RSV cases. No pediatric cases of COVID-19 were found in participating hospitals during the study period.

Conclusion:

These results strongly suggest that social distancing and other lockdown strategies are effective to slow down the spreading of common respiratory viral diseases and decreasing the need for hospitalization among children.
Evaluation of Ceftriaxone Plus Avibactam in an Intracellular Hollow Fiber Model of Tuberculosis: Implications for the Treatment of Disseminated and Meningeal Tuberculosis in Children
Authors: Srivastava Shashikant , van Zyl Johanna , Cirrincione Kayle , Martin Katherine , Thomas Tania , Deshpande Devyani , Alffenaar Jan-William , Seddon James A. , Gumbo Tawanda
Published: August 2020

Background:

Ceftazidime-avibactam is an effective agent for the treatment of tuberculosis (TB) but requires frequent administration because of a short half-life. Due to a longer half-life, ceftriaxone could allow intermittent dosing.

Methods:

First, we identified the MIC of ceftriaxone with 15 mg/L avibactam in 30 clinical Mycobacterium tuberculosis isolates. Next, 2 ceftriaxone exposure-effect studies in the intracellular hollow fiber model of TB (HFS-TB) that mimics disseminated disease in young children, were performed. Ceftriaxone was administered once or twice daily for 28 days to explore percentage of time that the concentration persisted above MIC (%TMIC) ranging from 0 to 100%. In a third HFS-TB experiment, the “double cephalosporin” regimen of ceftazidime-ceftriaxone-avibactam was examined and analyzed using Bliss Independence.

Conclusion:

The MIC99 of the clinical strains was 32 mg/L, in the presence of 15 mg/L avibactam. Ceftriaxone %TMIC <42 had no microbial effect in the HFS-TB, %TMIC
>54% demonstrated a 4.1 log10 colony-forming units per milliliter M. tuberculosis kill, while %TMIC mediating Emax was 68%. The “double cephalosporin” combination was highly synergistic. Monte Carlo experiments of 10,000 subjects identified the optimal ceftriaxone dose as 100 mg/kg twice a day.

Conclusion:

The combination of ceftriaxone-avibactam at 100 mg/kg could achieve Emax in >90% of children. The ceftriaxone potent activity M. tuberculosis could potentially shorten therapy in children with disseminated TB.
Reconstruction of Large Upper Eyelid Defects Using the Reverse Hughes Flap Combined With a Sandwich Graft of an Acellular Dermal Matrix
Authors: Eah Kyu Sang , Sa Ho-Seok
Published: August 2020

Purpose:

To investigate the usefulness of the reverse Hughes flap procedure combined with a sandwich graft of an acellular dermal matrix for reconstruction of large full-thickness defects of upper eyelids after cancer excision.

Methods:

Clinical data were obtained from patients who underwent upper eyelid reconstruction using a reverse Hughes flap combined with a sandwich graft of an acellular dermal matrix (AlloDerm) as a tarsal substitute. The tarsoconjunctival flap of the donor lower eyelid was mobilized to reconstruct the posterior lamella, and acellular dermal matrix was grafted onto the tarsoconjunctival flap. A skin-orbicularis muscle flap superior to the defect was advanced to cover the acellular dermal matrix graft, followed by application of lid crease formation sutures to prevent postoperative entropion. The tarsoconjunctival pedicle was divided 3–8 weeks after the surgery.

Results:

Six patients with sebaceous carcinoma were included, and all had ≥70% full-thickness upper eyelid defects after tumor excision. After a median follow-up of 40 months (range 6–62 months), all 6 showed satisfactory functional and cosmetic outcomes. Tumor recurrence, exposure keratopathy, upper eyelid entropion, persistent use of bandage contact lenses, lower eyelid deformity, and dermal matrix-related complications were not observed by the last follow-up.

Conclusions:

Reverse Hughes flap combined with a sandwich graft of an acellular dermal matrix as a tarsal substitute was successful in reconstructing large upper eyelid defects. Acellular dermal matrix graft and lid crease formation sutures enhance marginal stability and prevent postoperative entropion of the reconstructed upper eyelid.
Corrected sodium levels for hyperglycemia is a better predictor than measured sodium levels for clinical outcomes among patients with extreme hyperglycemia
Authors: Chuang Chien , Guo Ya-Wun , Chen Harn-Shen
Published: August 2020

Background:

Abnormal serum sodium levels in various diseases increase mortality; however, hyperglycemia depresses serum sodium concentration significantly. This study aimed to evaluate the clinical impact of measured serum sodium levels and corrected sodium levels among patients with severe hyperglycemia.

Methods:

Patients with blood glucose levels ≥500 mg/dL visiting the emergency department between July 2008 and September 2010 were enrolled retrospectively. The participants were divided into five groups for measured sodium levels and five groups for corrected sodium levels according to blood glucose levels. Multivariate Cox regression was used. The primary outcome was all-cause 90-day mortality. Secondary outcomes included rate of intensive care unit hospitalization, respiratory failure, and renal failure.

Results:

A total of 755 patients with severe hyperglycemia were enrolled, and the 90-day mortality was 17.2%. Compared with the reference group, the 90-day mortality was higher in the patients with measured hypernatremia (adjusted hazard ratio [HR], 2.86; 95% confidence interval [CI], 1.39–5.87), corrected hyponatremia (adjusted HR, 3.56; 95% CI, 1.44–8.80), and severe corrected hypernatremia (adjusted HR, 2.68; 95% CI, 1.28–5.62). However, patients with severe measured hyponatremia did not show increased mortality (adjusted HR, 1.67; 95% CI, 0.84–3.32).

Conclusion:

Among patients with severe hyperglycemia, corrected sodium level is a better indicator of clinical outcomes compared with measured sodium levels, especially in this population with measured hyponatremia.
Novel Calculators for Risk Stratification in Hepatocellular Carcinoma
Authors: Pirisi Mario , Leutner Monica , Romito Raffaele , Gaia Silvia
Published: August 2020

Among clinicians, the users of medical calculators have expanded in recent years to an unprecedented number. The usefulness of some of these calculators is sometimes debatable, and experienced professionals may at times be right in avoiding their use; however, many may simply be unaware of the very existence of medical calculators applicable to their field of interest. The authors felt that this latter scenario might possibly apply to hepatocellular carcinoma (HCC). Hence, the authors concisely reviewed 10 free online medical calculators proposed in the last 8 years, categorizing them on the basis of the purpose for which they were developed (risk of harboring or developing HCC, N=4; prognostication in established HCC, N=6). In addition, the authors tried to establish the success each calculator has had so far in the medical community, by 2 criteria: having been included in the more popular app of medical calculators and being highly cited in the scientific literature.
Thyroid effects of amiodarone: clinical update
Authors: Goundan Poorani N. , Lee Stephanie L.
Published: August 2020

Purpose of review

Amiodarone-induced thyroid dysfunction is well established and commonly encountered but is associated with several diagnostic and management challenges. The present review discusses recent evidence published related to the effects of amiodarone on the thyroid gland and thyroid function.

Recent findings

Retrospective studies to evaluate amiodarone-induced thyroid dysfunction in children show the occurrence of potential clinically significant changes within 2 weeks of amiodarone initiation that may not be detected if standard adult guidelines for thyroid hormone monitoring are followed. A small study evaluating beta-glucuronidase activity in amiodarone-induced thyrotoxicosis (AIT) demonstrated higher levels in patients with AIT type 2 compared to type 1. New data have suggested the incidence of agranulocytosis may be higher in patients on thionamides with AIT compared to hyperthyroidism because of other causes. In a small study, investigators demonstrated the use of a combination of intravenous and oral steroids to treat refractory AIT which needs to be evaluated in further controlled trials. Finally, recent data demonstrated a possible mortality benefit of surgery over medical therapy for AIT in patients with moderate to severe reduction in left ventricular ejection fraction.

Recent research regarding the prevalence, diagnosis, and management of amiodarone-induced thyroid dysfunction were reviewed.
Ketogenic diet as a metabolic treatment for mental illness
Authors: Norwitz Nicholas G. , Sethi Shebani , Palmer Christopher M.
Published: August 2020

Purpose of review

Ketogenic diets, which have been used to treat drug-refractory paediatric epilepsy for over 100 years, are becoming increasingly popular for the treatment of other neurological conditions, including mental illnesses. We aim to explain how ketogenic diets can improve mental illness biopathology and review the recent clinical literature.

Recent findings

Psychiatric conditions, such as schizophrenia, depression, bipolar disorder and binge eating disorder, are neurometabolic diseases that share several common mechanistic biopathologies. These include glucose hypometabolism, neurotransmitter imbalances, oxidative stress and inflammation. There is strong evidence that ketogenic diets can address these four fundamental diseases, and now complementary clinical evidence that ketogenic diets can improve the patients’ symptoms.

It is important that researchers and clinicians are made aware of the trajectory of the evidence for the implementation of ketogenic diets in mental illnesses, as such a metabolic intervention provides not only a novel form of symptomatic treatment, but one that may be able to directly address the underlying disease mechanisms and, in so doing, also treat burdensome comorbidities (see Video, Supplementary Digital Content 1, http://links.lww.com/COE/A16, which summarizes the contents of this review).